Korean J Transplant.  2022 Nov;36(Supple 1):S275. 10.4285/ATW2022.F-4149.

The effect of loupe magnification on occurrence of duct complication after liver transplantation: a single-center experience

• Jun J
• Choi HJ
• Park H
• Ahn J
• Hong TH
• You YK

• KMID: 2535502
• DOI: http://doi.org/10.4285/ATW2022.F-4149

Abstract

Background
Despite advances of surgical techniques, biliary complications are still considered to be a technical "Achilles' heel" of liver transplantation (LT) due to the high incidence, requiring long-term interventional treatment, and potential risk for graft failure. The purpose of this study was to evaluate the effect of loupe magnification in reducing biliary complications after LT.
Methods
From April 2017 to February 2022, LT was performed in 307 patients in Seoul St. Mary’s Hospital. Among them, except for three patients who underwent hepaticojejunostomy, 304 adult LT patients were enrolled. They were divided into three groups according to the loupe magnification: 2.5 times (×2.5 group, n=105), 3.5 times (×3.5 group, n=95), and 5.0 times (×5.0 group, n=105). By dividing biliary complication into bile leakage and stricture, the effect of loupe magnification on biliary complications after LT was analyzed.
Results
In all patients with LT, the mean age was 54.3 years, and 218 (71.7%) were male. Biliary complications occurred in 63 patients (20.7%). Anastomosis site leakage occurred in 37 patients (12.2%) and stricture occurred in 52 patients (17.1%). There was no difference between the three groups in the number and size of duct openings. Anastomosis site leakage occurred in 15 patients (14.3%) in the ×2.5 group, 15 patients (16.0%) in the ×3.5 group, and seven patients (6.7%) in the ×5.0 group (P=0.097). Biliary stricture occurred in 26 patients (24.8%) in the ×2.5 group, 15 patients (16.0%) in the ×3.5 group, and 11 patients (10.5%) in the ×5.0 group (P=0.021). Total duct complications occurred in 31 patients (29.5%) in the ×2.5 group, 19 patients (20.2%) in the ×3.5 group, and 13 patients (12.4%) in the ×5.0 group (P=0.009).
Conclusions
The use of a high-magnification loupe can reduce biliary complications in liver transplantation. Further large-scale analyses of clinical data or randomized controlled trial are required to support this study.