A New Technique for Bile Duct Reconstruction in Liver Transplantation

Biliary complications are one of the most important problems in liver transplantation. Despite various refinements of surgical technique, liver transplantation is associated with significant numbers of biliary problems. In this article, we describe our novel “intraoperative transhepatic biliary catheter insertion” technique for biliary reconstruction in 29 patients, since November 2004 comparing results before and after its implementation. 5-F Kumpe catheter is inserted into the biliary system in two steps. The first is completed at the back table, and the second during the recipient operation. The grafts were from cadavers in 10 cases, with the remaining ones from living donors. Ten patients received whole-liver grafts, 11 received a right lobe, and eight received a left-lateral lobe or left lobe. The mean weight of the living donor grafts was 598 g (range = 270 to 975 g). The mean graft weight-to-body weight ratio in the living donor liver transplantations was 1.6% ± 1.0% (range, 0.8% to 4.1%). Intraoperative transhepatic biliary catheter insertion was performed with a duct-to-duct anastomosis in 27 cases and with a Roux-en-Y hepaticojejunostomy in two cases. The only biliary complication was one case (3.4%) of bile leakage from the anastomotic site. This rate is significantly lower than that for duct-to-duct biliary reconstructions prior to the new catheter technique (13.0%; P < .05). This new technique of biliary reconstruction with intraoperative biliary catheter insertion has significantly reduced our biliary complication rate. Transhepatic biliary stenting prevents biliary complications and makes it simple to maintain percutaneous access in case such problems arise. However, further studies are needed to compare incidence rates of biliary complications when our novel technique is used versus other surgical techniques.