Surgical revision of biliary strictures following adult live donor liver transplantation: patient selection, morbidity, and outcomes

被引:16
作者
Reichman, Trevor W. [1 ]
Sandroussi, Charbel [1 ]
Grant, David R. [1 ]
Cattral, Mark S. [1 ]
Greig, Paul D. [1 ]
Levy, Gary [1 ]
McGilvray, Ian D. [1 ]
机构
[1] Univ Hlth Network, Toronto Gen Hosp, Multiorgan Transplant Program, 11-1250 NCSB,585 Univ Ave, Toronto, ON M5G 2N2, Canada
关键词
biliary stricture; complications; live donor liver transplantation; surgical repair; BILIOENTERIC ANASTOMOTIC STRICTURE; LIVING-DONOR; ENDOSCOPIC MANAGEMENT; COMPLICATIONS; RECONSTRUCTION; EXPERIENCE; COHORT;
D O I
10.1111/j.1432-2277.2011.01372.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Biliary strictures after live donor liver transplantation (LDLT) are frequent and difficult to manage. The outcomes of surgical correction of biliary anastomotic complications remain unclear. Clinical outcomes of patients requiring surgical revision of their biliary anastomosis following LDLT were analyzed. Of 296 consecutive right lobe LDLTs, approximately 21% of patients developed biliary strictures. Of these patients, twelve required surgical revision of a biliary anastomotic stricture. For patients who had operative repair, the average time from transplantation to stricture diagnosis was 7.6 months. Mean time to surgical correction was 8.2 months from the time of stricture diagnosis. Eight of 12 (67%) patients no longer require any intervention with a mean follow-up of 43.7 months. Two of 12 patients require intermittent medical treatment for presumed cholangitis, but have not required biliary interventions. Two patients have required chronic PTC catheter drainage. The 30-day postoperative morbidity was 58%, with four serious (Grade 3) complications occurring in three patients. Early stricture repair (<6 months from diagnosis of stricture) and younger donor grafts were associated with better surgical outcomes. Timely surgical correction of biliary strictures is successful and durable in appropriately selected patients. However, operative repair is associated with significant postoperative morbidity.
引用
收藏
页码:69 / 77
页数:9
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