The diagnosis and treatment of biliary complications in liver transplant patients / 中华普通外科杂志

ABSTRACT

Objective To investigate the treatment of biliary complications in perioperative stage of live transplantation. Methods From January 2007 to December 2009, 23 patients suffered from surgical biliary complications after liver transplantation. The clinical data including the types of biliary leakage,treatment, prognosis were analyzed retrospectively. Results Of 12 biliary leakage patients, 7 were anastomotic leakage, 3 with leakage of bile duct on the cutting surface of the graft of living ralated liver transplation, 1 with cystic duct leakage and 1 with leakage of aberrant biliary duct. Of 11 biliary stricture patients, 4 patients were anastomotic stenosis and 7 patients were no-anastomotic stenosis. The anastomotic biliary leakage of 7 patients was cured with biliary tract reconstruction in 2 patients, with cholangioenterostomy in 2 patients, with biliary reparation in 1 patient and peritoneal drainage in 1 patient but the patient with dual graft received re-transplantation. Three patients with biliary leakage on liver cut surface respectively receiving reparation or drainage were cured, of which 1 patient suffered from bile duct stricture and was finally cured by ERCP. One patient with biliary leakage of aberrant bile duct and 1 with biliary leakage of cystic duct were cured by salvage surgery. For the 4 patients with anastomotic stenosis, 3 patients were cured by ERCP and 1 patient recovered by biliary reconstruction. Among the patients with nonanastomotic stenosis, 3 cases were alleviated by ERCP or PTCD, another 3 patients had to receive retransplantation, of which 2 patients recovered well without surgery-related complications, one died of severe infection. Conclusions Biliary complications are common among liver transplant patients often causing significant mortality and morbidity necessitating comprehensive salvage procedures, though most of them are preventable.