• Rafael López-Andújar, Eva Montalvá Orón, Andrés Frangi Carregnato, Fabio Vergara Suárez, Angel Moya Herraiz, Fernando San Juan Rodríguez, Juan José Vila Carbó, Eugenia Pareja Ibars, Javier Escrig Sos, Angel Rubín Suárez, Martín Prieto Castillo, José Mir Pallardó, and Manuel De Juan Burgueño.
• HPB Surgery and Transplant Unit, Castellón General Hospital, Castellon, Spain. rlopezandujar@telefonica.net
• Ann. Surg. 2013 Jul 1; 258 (1): 21-9.

ObjectiveTo compare the incidence and severity of biliary complications due to liver transplantation after choledochocholedochostomy with or without a T-tube in a single-center, prospective, randomized trial.Summary Background DataThe usefulness of the T-tube for end-to-end biliary anastomosis to reduce the incidence of biliary complications in patients undergoing liver transplantation has been controversial.MethodsA per-protocol analysis was designed for liver recipients, who were randomly assigned to choledochocholedochostomy with (n = 95) or without (n = 92) a T-tube.ResultsThe overall biliary complication rate was 22.5% (n = 42), with no difference between groups (P = 0.35). The majority (66.7%) of complications in the T-tube group were types I and II, whereas 50% were type IIIa and 44% were type IIIb in the non-T-tube group (P < 0.0001). Fewer anastomotic strictures were found in the T-tube group (n = 2, 2.1%) than in the non-T-tube group (n = 13, 14.1%; P = 0.002). No difference in anastomotic biliary leakage was observed between groups. Biliary complication-free survival rates showed that complications appeared earlier in the T-tube group. Graft and patient survival rates were similar in both groups.ConclusionsComplications in the T-tube group were less severe and required less aggressive treatment. The incidence of anastomotic strictures was higher in patients with no T-tube. We recommend conducting choledochocholedochostomy with a rubber T-tube during liver transplantation in risky anastomosis and when the bile duct diameter is less than 7 mm. This study is registered at http://www.clinicaltrials.gov: Clinical trial ID# NCT01546064.

19 keywords...

hide…