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Biliary Complications after Choledochocholedochostomy without T-tube in Whole-Size Liver Transplantation in Adults

Ousmane KA, Olivier Boillot, Mustapha Adham, Pittau G and Gelas T

Introduction: It is reported that choledochocholedochostomy without T-tube presents fewer complications than biliary reconstruction using T-tube in liver transplantation. But there is no large homogeneous series which report late and early biliary complications after choledochocholedochostomy without T-tube in whole size liver transplantation in adults. The aim of our study was to report early and late biliary complications after choledochocholedochostomy without T-tube in whole-size liver transplantation in adults.
Materials and methods: Four hundred twenty six adult patients went whole-size liver transplantation with a biliary reconstruction performed by choledochocholedochostomy without T-tube. Forty six patients presented biliary complications. Incidence and treatment of early and late complications are studied.
Results: The overall biliary complications rate was 9.8%. Early and late biliary complications rates were respectively 50%. Early biliary complications were: 13 early anastomotic strictures (28.3% of overall biliary complications); 9 early anastomotic biliary leaks (19.6%) and 1 case of hemobilia (2.2%). In 3 patients, early anastomotic strictures were associated with early leaks (6.5%). There was 19 late supra anastomotic strictures developed on the graft side (41.3% of overall biliary complications); 3 late anastomotic biliary leaks (6.5%) and 1 biliary obstruction by a lymphoma (2.2%).
Conclusion: This study is a large and homogeneous series which find low rate of biliary complications in choledochocholedochostomy without T-tube in whole-size liver transplantation. There is no difference between early and late biliary complications accepted graft conservation injuries which are more frequent in late biliary complications. Strictures are more frequent than leaks in the 2 groups. Both endoscopic and surgical treatments have a good prognosis.