Prospective randomized trial of end-to-end versus side-to-side biliary reconstruction after orthotopic liver transplantation

Background: Biliary reconstruction is the Achilles heel of liver transplant ation. Side-to-side anastomosis of donor and recipient bile duct has been c laimed to be superior to end-to-end anastomosis in uncontrolled studies. Methods: A total of 100 consecutive patients undergoing orthotopic liver tr ansplantation were randomized after commencement of the transplant procedur e to end-to-end or side-to-side anastomosis. No T tube drainage was employe d. Endoscopic retrograde cholangiography was performed 2 weeks after transp lantation and findings were reported by an experienced endoscopist as norma l, leak or stricture. Median follow-up was 53 (range 35-63) months. Results: Patient age, sex, the graft preservation time and indication for t ransplantation were similar in both groups. Sixty patients received end-to- end and 40 side-to-side anastomosis. Ten patients randomized to side-to-sid e anastomosis had an end-to-end procedure. The total number of biliary comp lications was similar in both groups (end-to-end 32 per cent versus side-to -side 30 per cent) as were the number of leaks (17 versus 18 per cent) and biliary strictures (15 versus 12 per cent). There was no difference in the number of biliary complications that required interventional treatment (22 per cent in both groups). Conclusion: Side-to-side and end-to-end biliary anastomosis at liver transp lantation are equally effective.