Surgical strategies of re-operation for non-anastomotic biliary duct stricture after liver transplantation / 解放军医学杂志

ABSTRACT

ObjectiveTo investigate the re-operation timing and surgical modality for non-anastomotic biliary stricture (NABS) after orthotopic liver transplantation (OLT). MethodsThe clinical data of 14 NABS patients hospitalized in our center from August 2003 to April 2014 were analyzed retrospectively. The patients were treated with different modalities of re-operation according to cholangiographic results, and the outcomes of re-operation were noted by postoperative follow-up. ResultsAmong 421 OLT patients, NABS was seen in 14 (3.3%, 14/421), and it was accompanied by stenosis of hepatic artery in 4. Their total bilirubin, ALP and r-GGT levels were significantly higher in NABS patients than in non-NABS patients (P<0.01). According to cholangiographic findings, NABS was divided into 3 types hepatic bile duct strictures (4 patients, type Ⅰ), multiple extrahepatic and intrahepatic biliary strictures (8 patients, type Ⅱ), intrahepatic biliary stricture (2 patients, type Ⅲ). The cure rate of interventional treatment in this study was 57.1% (8/14), and 6 patients eventually required surgical treatment again. The type Ⅰ patient was treated with Roux-en-Y anastomosis, and re-transplantation for other 5 patients (type Ⅱ in 4 and type Ⅲ in 1). Among these 5 patients receiving liver re-transplantation, 1 patient died of perioperative fungal infection. The blood loss (2570±851ml) and operation time (492±173min) in those re-transplantation patients were almost the same as their previous-transplantation (P＞ 0.05). More than half of type Ⅱ and Ⅲ patients needed re-transplantation, but the probability of re-transplantation was especially higher for those with hepatic artery stenosis (75%, 3/4). Cholangitis disappeared and the total bilirubin significantly reduced from 123.4μmol/L to 31.6μmol/L after resurgery. ConclusionsFor those NABS patients who may fail to be improved after a minimally invasive treatment, especially when it was combined with hepatic arterial stenosis, resurgical treatment should be carried out timely to avoid the loss of a chance for re-operation. Based on the different types of stricture as shown by cholangiographic images, different modalities for re-operation should be adapted, and both Roux-en-Y anastomosis and re-transplantation are optional for the treatment of NABS.