To explore the role of Roux-en-Y choledochojejunostomy in the treatment of extrahepatic biliary complications after liver transplantation.

Clinical data of 109 patients suffered biliary complications after orthotopic liver transplantation(OLT) in the Third Affiliated Hospital of Sun Yat-Sen University, from March 2003 to March 2008 were analyzed retrospectively. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. All the patients were divided into the Roux-en-Y group and non-Roux-en-Y group, according to the different treatment of biliary complications after LT. There were 31 males and 9 females in the Roux-en-Y group (age ranging from 25-69, median age of 47), including 4 cases of bile leakage, 31 cases of biliary stricture and 5 cases of biliary sludge or stones. There were 56 males and 13 females in the non-Roux-en-Y group (age ranging from 31-59, median age of 45), including 3 cases of bile leakage, 41 cases of biliary stricture, 19 cases of cholangitis and 6 cases of biliary stones or sludge. Duct-to-Duct anastomosis was performed to reconstruct the biliary tract in the primary liver transplantation. Patients in the Roux-en-Y group received Roux-en-Y choledochojejunostomy, while the patients in the non-Roux-en-Y group underwent one of the following operations such as endoscopic retrograde cholangiopancreatography(ERCP) and nasobiliary drainage, percutaneous transhepatic cholangial drainage(PTCD), hepatic artery stents as well as biliary stents. The patients were followed up. The mortality, treatment outcome of biliary complications, mortality of biliary infection of all patients in two groups were observed and compared by chi-square test.

All the patients were followed up for 6-24 months(median: 15 months). No death was observed in the Roux-en-Y group and 4 cases in the non-Roux-en-Y group died of severe biliary infection after liver transplantation and/or other organ infections. The improvement rate of biliary complications in the Roux-en-Y group was 78%(31/40), which was evidently higher than that of non-Roux-en-Y group(70%, 48/69) (χ²=32.571, P<0.01). The incidence of biliary infection in the Roux-en-Y group was 61%(19/31) and was 63% (30/48) in the non-Roux-en-Y group, which showed no significant difference (χ²=0.060, P>0.05).

The Roux-en-Y choledochojejunostomy can obviously improve the clinical symptoms of the patients with extrahepatic biliary complications after OLT and it is applicable and feasible in treating the extrahepatic biliary complications.