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Biliary complications after liver transplantation: With special reference to the biliary cast syndrome and techniques of secondary duct repair

Starzl, TE and Putnam, CW and Hansbrough, JF and Porter, KA and Reid, HAS (1977) Biliary complications after liver transplantation: With special reference to the biliary cast syndrome and techniques of secondary duct repair. Surgery, 81 (2). 212 - 221. ISSN 0039-6060

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Abstract

In 93 consecutive cases of orthotopic liver transplantation, there were 24 examples of biliary obstruction and eight of bile fistula formation. Six of the obstructed livers developed biliary cast formation so extensive that the smaller intrahepatic ducts became plugged to an extent that they could no longer have been treated by surgical means. In each of the six cases, the most important causative factor was neglected obstruction of the large bile ducts with the intrahepatic lesions apparently being late and secondary. Stone and/or cast formation also occurred in other obstructed livers in the presence of bile fistulas, but these deposits were limited to the large ducts where they could have been or were removed. Although homograft bile undoubtedly has increased lithogenicity at certain postoperative times, the data from the present study have shown that biliary sludge formation essentially is always associated with defective bile duct reconstruction, and the observations have underscored the urgency with which reoperation must be considered. Techniques of secondary intervention have been described, with emphasis on conversion of cholecystojejunostomy to choledochojejunostomy. This operation has permitted salvage of homografts in eight of nine trials and the survival of seven patients. © 1977.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Starzl, TEtes11@pitt.eduTES11
Putnam, CW
Hansbrough, JF
Porter, KA
Reid, HAS
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1977
Date Type: Publication
Journal or Publication Title: Surgery
Volume: 81
Number: 2
Page Range: 212 - 221
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0039-6060
Other ID: uls-drl:31735062109891, Starzl CV No. 388
Date Deposited: 08 Apr 2010 17:06
Last Modified: 19 Jan 2019 13:55
URI: http://d-scholarship.pitt.edu/id/eprint/3774

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