CHOLEDOCHOCHOLEDOCHOSTOMY, A RELATIVELY SAFE PROCEDURE IN ORTHOTOPIC LIVER-TRANSPLANTATION

  • 1 January 1985
    • journal article
    • research article
    • Vol. 97  (5) , 552-556
Abstract
The biliary anastomosis has been considered the Achilles heel of liver transplantation, and especially the choledochocholedochostomy has been reported to be ill-fated. Based on previous experimental experiences, choledochocholedochostomy was used as the biliary anastomosis of preference in orthotopic liver transplantation. A choledochocholedochostomy was performed in 29 of 31 patients who have undergone transplantation since 1979. Five complications (17%) were diagnosed, of which 1 proved to be fatal. Two complications were related to the handling of the T-tube and required simple laparotomy to solve the i.p. bile leakage. The older 3 complications were major; in 1 patient the choledochocholedochostomy was stenosed, requiring a conversion into a hepaticojejunostomy, while in 2 patients the donor common bile duct became necrotic. One of these patients underwent successful retransplantation, while the other died of sepsis. In both patients the hepatic artery anastomosis was thrombosed, while in all patients without biliary complications the hepatic artery anastomosis was patent angiographically or at autopsy. The total incidence of sepsis was 26%, but in only 4 patients (13%) was sepsis related to the choledochocholedochostomy. The relationship between the necrosis of the donor bile duct and the patency of the hepatic artery anastomosis emphasizes an impeccable surgical technique. The low incidence of biliary complications in the 31 patients characterizes the choledochocholedochostomy as a relatively safe biliary procedure in clinical liver transplantation.

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