Duct‐to‐duct biliary reconstruction in pediatric living donor liver transplantation

Abstract

The results of duct-to-duct biliary reconstruction in six pediatric patients who received a living donor liver transplant aged from 2 months to 11 yr old are reported. The graft was either entire or a part of the left lateral segments. The orifice of the bile duct of the graft was anastomosed to the recipients' hepatic duct in an end-to-end fashion by interrupted suture using 6-0 absorbable material. A transanastomotic external stent tube (4 Fr) was passed through the stump of the recipients' cystic duct. Mean time for reconstruction was 24 min. All the recipients survived the operation and reinitiated oral intake on postoperative day 3. There were no early biliary complications. One 5-yr-old boy suffered from an anastomotic stenosis 9 months after transplantation. He underwent re-anastomosis by Roux-en Y (R-Y) procedure and recovered uneventfully. Duct-to-duct anastomosis in pediatric living donor liver transplantation has benefits while the complication rate is comparable to R-Y reconstruction.

Biliary reconstruction for infantile living donor liver transplantation: Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy?

“…We employed DD for biliary reconstruction, even for pediatric LDLT in principle, when the recipient's common bile duct was available. We have previously reported the results of duct‐to‐duct reconstruction for LDLT for pediatric patients, including infants 8. The present report is a small (but so far the largest) retrospective study of the viability of the duct‐to‐duct technique for infantile LDLT.…”

Biliary reconstruction in pediatric live donor liver transplantation: duct-to-duct or Roux-en-Y hepaticojejunostomy

“…However, only a few case reports discuss the feasibility of DD in pediatric LDLT. Okajima et al [10] reported on 6 pediatric LDLT cases with DD and observed only 1 biliary complication (stenosis). Kimura et al [11] reported on successful DD in 3 pediatric LDLTs.…”

“…Endoscopic nasobiliary or retrograde biliary drainage is indicated as an initial treatment of biliary leakage or stricture in patients who had DD in adult-to-adult LDLT [7,9]. Okajima et al [10] reported on endoscopic retrograde cholangiography as a diagnostic tool for a 5-year-old boy with biliary stricture after LDLT with DD. Sakamoto et al [12] used endoscopic retrograde biliary drainage in 4 biliary complications after pediatric LDLT with DD, and those patients were 10 to 16 years old.…”

“…(3) Anatomical bilioenteric continuity enables good endoscopic access postoperatively [9]. However, only a few reports have addressed the feasibility of DD for pediatric LDLT [10][11][12].…”

Single-center experience and long-term outcomes of duct-to-duct biliary reconstruction in infantile living donor liver transplantation

“…Several programs have reported that DD biliary reconstruction leads to more biliary complications in comparison with RY hepaticojejunostomy, especially in small infants weighing less than 10 kg . In our experience, however, DD reconstruction for pediatric cases, including infants, has led to excellent outcomes during the short‐term follow‐up period . In the present study, long‐term outcomes were evaluated for DD biliary reconstruction versus RY hepaticojejunostomy in pediatric recipients with a body weight less than 10 kg at the time of transplantation.…”