[Biliary reconstruction in liver transplantation: is a biliary tutor necessary?]. / Reconstrucción biliar en el trasplante hepático: es necesario un tutor biliar.

OBJECTIVES: To assess the incidence and type of biliary complications in liver transplantation after biliary reconstruction with or without a biliary tutor. MATERIAL AND METHOD: A prospective, non-randomized study of 128 consecutive patients undergoing elective liver transplantation was performed. Retransplantations, emergency transplantations, hepaticojejunostomy and patients who died within 3 months of causes other than biliary complications were excluded. Group I (n = 64) underwent termino-terminal choledochocholedochostomy with a Kehr tube and group II (n = 64) underwent choledochocholedochostomy without Kehr tube. Complications, therapeutic procedures, reoperations and survival free of biliary complications were analyzed. RESULTS: The overall rate of biliary complications was 15% (17% in group I and 14% in group II). Types of complication (overall and in groups I and II, respectively) consisted of fistulas 4% (6% vs. 3%), stenosis 8% (4% vs. 12%), and Kehr dysfunction 3%. The mean number of therapeutic procedures, including endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, trans-Kehr cholangiography and drainage of collections, was 2.1 vs. 2 per complicated patient. The overall reoperation rate was 5% (2% vs. 9%) (p < 0.05). One-year survival free of biliary complications was 85% vs. 82% (Log Rank = 0.5). CONCLUSIONS: No statistically significant differences were found in complications after choledocho-choledocho anastomosis with or without a biliary tutor. However, the patient group that did not receive a biliary tutor required more complex procedures for treatment of complications, as well as a greater number of reoperations.

Reconstrucción biliar en el trasplante hepático: es necesario un tutor biliar / Biliary reconstruction in liver transplantation: is a biliary tutor necessary

Objetivos. Evaluar la incidencia y el tipo de complicaciones biliares en el trasplante hepático tras la reconstrucción biliar con y sin tutor biliar. Material y método. Estudio prospectivo no aleatorizado en el que se incluyó a 128 pacientes consecutivos sometidos a trasplante hepático electivo, excluyendo del estudio los retrasplantes, trasplantes urgentes, hepaticoyeyunostomía y pacientes fallecidos durante los primeros 3 meses por causas distintas de las complicaciones biliares. En el grupo I (n = 64) se realizó coledococoledocostomía terminoterminal sobre tubo de Kehr y en el grupo II (n = 64), coledococoledocostomía sin tubo de Kehr. Se analizan las complicaciones, los procedimientos terapéuticos, reintervenciones y supervivencia libre de complicaciones biliares. Resultados. La tasa general de complicaciones biliares es del 15% (el 17% en el grupo I y el 14% en el grupo II). En relación con el tipo de complicaciones (grupo I contra grupo II) se observó: fístulas, 4% (el 6 contra el 3%); estenosis, 8% (el 4 contra el 12%); disfunciones del tubo de Kehr, 3%. La media de procedimientos terapéuticos, incluidos colangiografía endoscópica, colangiografía transhepática, colangiografias trans-Kehr y drenaje de colecciones, es 2,1 frente a 2 por paciente complicado. La tasa general de reintervenciones es del 5% (el 2 contra el 9%) (p < 0,05). La supervivencia libre de complicaciones biliares al año es del 85 contra el 82% (test de rangos logarítmicos, 0,5). Conclusiones. No se ha encontrado diferencias estadísticamente significativas de complicaciones tras la anastomosis coledococolédoco con y sin tutor biliar. Sin embargo, el grupo de pacientes en los que no se utilizó tutor biliar ha precisado para el tratamiento de la complicaciones procedimientos más complejos, así como mayor número de reintervenciones (AU)

Objectives. To assess the incidence and type of biliary complications in liver transplantation after biliary reconstruction with or without a biliary tutor. Material and method. A prospective, non-randomized study of 128 consecutive patients undergoing elective liver transplantation was performed. Retransplantations, emergency transplantations, hepaticojejunostomy and patients who died within 3 months of causes other than biliary complications were excluded. Group I (n = 64) underwent termino-terminal choledochocholedochostomy with a Kehr tube and group II (n = 64) underwent choledochocholedochostomy without Kehr tube. Complications, therapeutic procedures, reoperations and survival free of biliary complications were analyzed. Results. The overall rate of biliary complications was 15% (17% in group I and 14% in group II). Types of complication (overall and in groups I and II, respectively) consisted of fistulas 4% (6% vs. 3%), stenosis 8% (4% vs. 12%), and Kehr dysfunction 3%. The mean number of therapeutic procedures, including endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, trans-Kehr cholangiography and drainage of collections, was 2.1 vs. 2 per complicated patient. The overall reoperation rate was 5% (2% vs. 9%) (p < 0.05). One-year survival free of biliary complications was 85% vs. 82% (Log Rank = 0.5). Conclusions. No statistically significant differences were found in complications after choledocho-choledocho anastomosis with or without a biliary tutor. However, the patient group that did not receive a biliary tutor required more complex procedures for treatment of complications, as well as a greater number of reoperations (AU)