T tubes are commonly used to splint biliary anastomoses after liver transplantation. Although several advantages are claimed for this approach, there is undoubtedly some iatrogenic morbidity associated with the use of T tubes in this situation. We have evaluated 120 consecutively biliary reconstructions after liver transplant, the majority of which are unsplinted end to end bile duct anastomoses. We have shown that biliary leakage and stricture rates are not significantly affected by T tubes. We have also shown that endoscopic retrograde cholangiopancreatography and percutaneous cholangiography are reliable and posttransplant methods for cholangiography and structure dilstation.
Routine T tube splintage of post-liver transplant biliary anastomoses is unjustified.
Comments
The modem era of liver transplantation has prided itself on its relative absence of technical complications. These advances, along with newer immunosuppressive regimens and improved recognition and treatment of complications, have resulted in outcomes that are significantly improved over those from the 1970s and 1980s. The current article represents another step in the continuum of technical advances designed to reduce morbidity after liver transplantation.
The earliest techniques of biliary drainage after
From the Liver Transplant Program,