Biliary Reconstruction in Right Lobe Living-Donor Liver Transplantation

Abstract

The authors found an increase in the biliary stricture rate in the duct-to-duct choledochocholedochostomy group. Because of greater physiologic bilioenteric continuity, less incidence of leakage, and easy endoscopic access, duct-to-duct reconstruction represents a feasible technique in right lobe LDLT.

Duct-to-Duct Biliary Reconstructions and Complications in 100 Living Donor Liver Transplantations

“…Although the Kyoto group reported that they recently started to use 7-0 monofilament suture, they did not report the outcomes of using this material. 2 Recently, Yan et al 15 reported the favorable results of a microsurgical technique for biliary reconstruction of small hepatic ducts with 8-0 Prolene. In the future, further study with larger numbers of patients using smaller suture materials for the biliary anastomosis should be initiated to determine the effective method to reduce the incidence of biliary complications.…”

“…Incidences of up to 40% have been reported for long-term biliary complications among duct-to-duct biliary reconstructions in right or left lobe LDLT. [1][2][3][4] Biliary stricture and leakage at the anastomotic site are major concerns since they are strongly associated with surgical techniques of bile duct preparation and anastomosis.…”

“…5,6 However, the type of suture technique, selection of suture material, and use of stents are still debated. 2,3,7 Duct-to-duct biliary reconstructions in LDLT have been popular at our center since 2005. We have performed 4 biliary anastomotic procedures according to the type of anastomosis, suture material, and use of an external stent.…”

Ischemic Type Biliary Lesions

“…Furthermore, patients with advanced liver disease before transplantation seem to be more likely to develop ITBL compared to lower Child and Pugh-stages [1]. Deteriorated preoperative status, early biliary complications and "small-for-size" transplantation are currently suspected to contribute to the occurrence and progression of ITBL [55]. Further potential confounders regarding the recipient (age, gender) do not seem to play a significant role in the pathogenesis of ITBL [1].…”

“…Bacterial ascension leading to cholangitis may negate the expected advantage of reduced cold ischemia time [55,57]. Thus, the main advantages of choledocho-choledochostomy comprise the integrity of anatomic barrier regarding the reflux of intestinal flora to a great extent, better technical feasibility than Roux-en-Y and physiological condition for an endoscopic access [35,58].…”