Roux-en-Y Choledochojejunostomy is the method of choice for biliary reconstruction in liver transplantation for primary sclerosing cholangitis.

Background: Opinion is divided regarding the optimal method of biliary reconstruction after liver transplantation for primary sclerosing cholangitis (PSC).

Methods: We investigated biliary complications and graft and patient survival in all patients who underwent liver transplantation for PSC in the United Kingdom between 1994 and 2003.

Results: Anastomotic leak rates were similar, but a significantly higher stricture rate was observed in patients who had a duct-to-duct reconstruction compared with those who underwent a Roux-en-Y anastomosis. Graft and patient survival were also markedly worse in patients with a duct-to-duct anastomosis.

Conclusions: Roux-en-Y choledochojejunostomy is the method of choice for biliary reconstruction in liver transplantation for PSC.