Intrahepatic bilioenteric anastomosis after biliary complications of liver transplantation: Operative rescue of surgical failures

Miguel Ángel Mercado, Mario Vilatobá, Carlos Chan, Ismael Domínguez, Rafael Paulino Leal, Marco Antonio Olivera

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Biliary complications after orthotopic liver transplantation (OLT) are multifactorial in origin. In most series, the frequency of such complications ranges from 5-20%. Most can be treated by endoscopy and/or interventional radiology. For cases in which this option is not successful, surgical approach is indicated. We report the results of reoperation using an intrahepatic bilioenteric anastomosis. Methods: The medical charts of patients with biliary complications after OLT during a 10-year period (1997-2007), who failed to respond to nonsurgical treatment and were surgically treated, were reviewed. Roux-en-Y hepatojejunostomy was performed. Segments IV and V were partially removed after cutting the hilar plate, thus obtaining healthy ducts without ischemic or inflammatory reaction and allowing a wide hepatojejunostomy. Results: Five cases (8.4%) with biliary complications after duct-to-duct anastomosis not amenable to further endoscopic management or interventional radiology were identified. Hepaticojejunostomy was achieved in all cases (wide, tension-free, nonischemic, fine hydrolyzable sutures), and segments IV and V were partially removed. No cholangitis, jaundice, and liver function test abnormalities were present in the postoperative. Mean follow-up was 24 months. Only one patient died of causes not related to bile duct reconstruction during follow-up. Conclusions: Intrahepatic hepatojejunostomy with partial resection of segments IV and V offers an excellent therapeutic alternative for biliary complications that require a surgical approach after OLT.

Original languageEnglish (US)
Pages (from-to)534-538
Number of pages5
JournalWorld Journal of Surgery
Volume33
Issue number3
DOIs
StatePublished - Mar 1 2009

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Liver Transplantation
Interventional Radiology
Cholangitis
Liver Function Tests
Jaundice
Bile Ducts
Reoperation
Sutures
Endoscopy
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Intrahepatic bilioenteric anastomosis after biliary complications of liver transplantation : Operative rescue of surgical failures. / Mercado, Miguel Ángel; Vilatobá, Mario; Chan, Carlos; Domínguez, Ismael; Leal, Rafael Paulino; Olivera, Marco Antonio.

In: World Journal of Surgery, Vol. 33, No. 3, 01.03.2009, p. 534-538.

Research output: Contribution to journalArticle

Mercado, Miguel Ángel ; Vilatobá, Mario ; Chan, Carlos ; Domínguez, Ismael ; Leal, Rafael Paulino ; Olivera, Marco Antonio. / Intrahepatic bilioenteric anastomosis after biliary complications of liver transplantation : Operative rescue of surgical failures. In: World Journal of Surgery. 2009 ; Vol. 33, No. 3. pp. 534-538.
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