In the latest issue of Ochsner Journal with its focus on transplantation, Carmody and colleagues present the results of a retrospective study comparing the outcomes of biliary transposition and biliary ductoplasty used during liver transplantation. Biliary anastomosis has come a long way from the early practices of Roux-en-Y and loop choledochojejunostomy, drainage with a T-tube, and more recently, omitting the T-tube altogether during reconstruction. Although patient outcomes have improved with the evolution of the procedure, complications still arise such as leaks, fistula, and infection.
This study involved standard liver transplant procedure with the difference occurring at the biliary reconstruction stage. In spite of the small and heterogeneous sample size, results favored the use of biliary transposition over ductoplasty in patient survival, graft survival, postoperative complication rates, stricture formation, and hepatitis C virus recurrence rates.