External Biliary Fistula in Orthotopic Liver Transplantation

• Published in: Transplantation proceedings Vol. 41; no. 4; pp. 1316 - 1318
• Main Authors: Gilbo, N, Mirabella, S, Strignano, P, Ricchiuti, A, Lupo, F, Giono, I, Sanna, C, Fop, F, Salizzoni, M
• Format: Journal Article Conference Proceeding Web Resource
• Language: English
• Published: Amsterdam Elsevier Inc 01-05-2009; Elsevier; Appleton & Lange
• Subjects: Biliary Fistula - etiology; Biological and medical sciences; Chirurgie; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Human health sciences; Humans; Liver Transplantation - adverse effects; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Sciences de la santé humaine; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Medicine; Biliary tract; Orthotopic transplantation; Treatment; Digestive system; Surgery; Liver; External; Graft; Fistula; Homotransplantation; Liver transplantation
• ISSN: 0041-1345; 1873-2623; 1873-2623
• DOI: 10.1016/j.transproceed.2009.03.026

Abstract During orthotopic liver transplantation (OLT), various situations may occur in which biliary reconstruction is neither technically feasible nor recommended. One bridge to a delayed anastomosis can be an external biliary fistula (EBF). This procedure allows the surgeon to execute hemostatic maneuvers, such as abdominal packing; therefore, biliary reconstruction can be subsequently performed in a bloodless operative field without edematous tissues. EBF can be made by placing in the donor biliary tract a cannula that is fixed to the bile duct using 2–0 silk ties and secured outside the abdominal wall. The biliary anastomosis will be performed within 2 days after the OLT. The aim of this study was to examine the safety of EBF in terms of the incidence of biliary complications compared with a direct anastomosis. Among 1634 adult OLTs performed in 17 years in our center, 1322 were carried out with termino-terminal hepaticocholedochostomy (HC-TT); two with side-to-side hepaticocholedochostomy; 208 with hepaticojejunostomy (HJ); 31 with EBF and delayed HC-TT, and 71 with EBF and delayed HJ. Biliary complication rates in the EBF group were 24.5%, including 23.9% in the delayed HJ and 25.8% in the delayed HC-TT. Biliary complication incidence among all OLTs was 24.6% ( P = NS). No complications related to the procedure were observed. Therefore, EBF is a safe technique without a higher biliary complication rate. It may be useful when a direct biliary anastomosis is dangerous.