Surgical Outcomes of Pair-Watch Suturing Technique (PWST) for Duct-To-Duct Biliary Anastomosis in an Attempt to Reduce the Biliary Complications in Living Donor Liver Transplantation.
Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan
Meeting: 2017 American Transplant Congress
Abstract number: B229
Keywords: Bile duct, Liver transplantation, Living-related liver donors, Surgical complications
Session Information
Session Name: Poster Session B: Living Donors and Partial Grafts
Session Type: Poster Session
Date: Sunday, April 30, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Objectives:
Biliary stricture is one of the major complications after living donor liver transplantation (LDLT) with duct-to-duct biliary reconstruction. To prevent biliary stenosis, we have adopted the intermitted sutures with twelve-stitches, named Pair-Watch suturing technique (PWST: World J Gastrointest Surg 2010), in duct-to-duct biliary anastomosis since 2008. We evaluated the surgical outcomes of recipients undergoing LDLT with duct-to-duct biliary reconstruction, focusing the procedure of biliary anastomosis and biliary stricture requiring surgical revision.
Patients and Methods:
Among 123 cases of consecutive adult-to-adult LDLT from March 2002 to November 2016, 116 recipients who underwent duct-to-duct biliary reconstruction were analyzed. We divided them into two groups according to the procedure with or without PSWT: Non-PSWT group (n=90) and PWST group (n=26). As a sub-analysis, 20 cases with postoperative biliary stricture were evaluated, dividing them into two groups according to their treatment: patients who did not need surgical treatment (Non-op group: n=15) and patients who needed surgical treatment (Op group: n=5).
Results:
The rate of left graft was significantly higher, and graft weight and GRWR were significantly lower in PWST group than in Non-PWST group (18% vs 31%, p=0.0001, 489±126g vs 610±142g, p=0.0001, and 0.79±0.22 vs 0.99±0.20, p=0.0004). The frequency of biliary stenosis was similar between the two groups (19% and 17%). Biliary leakage occurred in 6 case (7%) in Non-PWST group, while no case experienced that in PWST group. In multivariate analysis, hepatic artery thrombosis (HAT) was only risk factor for biliary stenosis. In analysis of the cases with biliary stricture, MELD score and graft volume were significantly higher in Non-op group than in Op group (18.5±11.5 vs 10.6±3.0, p=0.02, and 610±168g vs 468±69g, p=0.03). In Op group, all 5 cases was successfully treated by hepaticojejunostomy without any recurrences of biliary stenosis.
Conclusion:
PWST tended to be performed in smaller graft like left graft. PWST could prevent biliary leakage, although it did not reduce the rate of biliary stricture. PWST was thought to be safe and feasible method, especially in left graft with small bile duct.
CITATION INFORMATION: Tanemura A, Iizawa Y, Kato H, Murata Y, Kuriyama N, Azumi Y, Kishiwada M, Mizuno S, Usui M, Sakurai H, Isaji S. Surgical Outcomes of Pair-Watch Suturing Technique (PWST) for Duct-To-Duct Biliary Anastomosis in an Attempt to Reduce the Biliary Complications in Living Donor Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Tanemura A, Iizawa Y, Kato H, Murata Y, Kuriyama N, Azumi Y, Kishiwada M, Mizuno S, Usui M, Sakurai H, Isaji S. Surgical Outcomes of Pair-Watch Suturing Technique (PWST) for Duct-To-Duct Biliary Anastomosis in an Attempt to Reduce the Biliary Complications in Living Donor Liver Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/surgical-outcomes-of-pair-watch-suturing-technique-pwst-for-duct-to-duct-biliary-anastomosis-in-an-attempt-to-reduce-the-biliary-complications-in-living-donor-liver-transplantation/. Accessed June 17, 2025.« Back to 2017 American Transplant Congress