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Biliary Duct-to-Duct Reconstruction with a Tunneled Retroperitoneal T-Tube During Liver Transplantation: a Novel Approach to Decrease Biliary Leaks After T-Tube Removal

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Abstract

The benefit of placing a T-tube for duct-to-duct biliary reconstruction during orthotopic liver transplantation (OLT) remains controversial because it could be associated with specific complications, especially at the time of T-tube removal. While the utility of T-tube during OLT represents an eternal debate, only a few technical refinements of T-tube placement have been described since the report of the original technique by Starzl and colleagues. Herein, we present a novel technique of T-tube placement for duct-to-duct biliary reconstruction during OLT, using a tunneled retroperitoneal route. On the basis of our experience of 305 patients who benefitted from the reported technique, the placement of a tunneled retroperitoneal biliary T-tube appears to be safe and results in a low rate of biliary complications, especially at the time of T-tube removal.

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Abbreviations

BC:

Biliary complication

CMV:

Cytomegalovirus

HCC:

Hepatocellular carcinoma

ICU:

Intensive care unit

MELD:

Model for end-stage liver disease

NASH:

Non-alcoholic steatohepatitis

OLT:

Orthotopic liver transplantation

RFA:

Radiofrequency ablation

TACE:

Transarterial chemoembolization

TIPSS:

Transjugular intrahepatic porto-systemic shunt

TRBT:

Tunneled retroperitoneal biliary T-tube

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Authors’ Contribution

JN and KM collected and analyzed the data and wrote the manuscript.

BD and JBC interpreted the data and critically revised the manuscript.

CD and JYM designed the study and critically revised the manuscript.

Author information

Correspondence to Kayvan Mohkam.

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Source of Funding

The authors have no source of funding to disclose for the present work.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Navez, J., Mohkam, K., Darnis, B. et al. Biliary Duct-to-Duct Reconstruction with a Tunneled Retroperitoneal T-Tube During Liver Transplantation: a Novel Approach to Decrease Biliary Leaks After T-Tube Removal. J Gastrointest Surg 21, 723–730 (2017) doi:10.1007/s11605-016-3313-x

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Keywords

  • Liver transplantation
  • Biliary reconstruction
  • T-tube
  • Bile leakage
  • Peritonitis