Roux‐en‐Y hepatico‐jejunostomy for a left segmental graft: Do not twist the loop, stick it!

Abstract

Biliary complications remain a major challenge for long-term success after LT, as it is, as a rule, the most common technical - early and late - complication that occurs, and because these complications contribute to a significant number of late graft losses and retransplantations. In the pediatric age group, both biliary atresia, as the patient's condition, and the use of a left liver graft, obtained by a liver division technique, make it necessary for the use of a Roux-en-Y jejunal loop for the biliary reconstruction in the majority of cases. A slight modification of the technique is presented, consisting of a straight positioning along the cut surface (rather than the conventional position that results in a harpoon shape). A favorable outcome in terms of a technical complication and graft survival was observed. This way of doing this is an interesting variation and adds to the surgical armamentarium.

Total internal biliary diversion during liver transplantation for type 1 progressive familial intrahepatic cholestasis: a novel approach

“…A 35‐cm loop of jejunum taken at 35 cm from the duodeno‐jejunal flexure and brought up to the graft in a retro‐colic fashion was used to construct the hepaticojejunostomy (posterior continuous and anterior interrupted sutures of 6‐0 PDS). Care was taken to prevent any twists in the jejunum or the mesentery . During the anastomosis, an interno‐external drain was placed in the graft hepatic duct, across the biliary anastomosis and exiting out of the jejunum externally onto the skin in the right hypochondrium.…”

“…Care was taken to prevent any twists in the jejunum or the mesentery. 7 During the anastomosis, an interno-external drain was placed in the graft hepatic duct, across the biliary anastomosis and exiting out of the jejunum externally onto the skin in the right hypochondrium. The caudal end of the jejunum conduit was tapered across the terminal 5 cm as one measure to prevent colo-jejunal reflux.…”

A paradigm shift in the intention‐to‐transplant children with biliary atresia: Outcomes of 101 cases and a review of the literature

“…12 The transplant techniques and the routine prophylaxis of vascular thrombosis have been detailed by the authors in previous publications. [13][14][15][16][17] The immunosuppressive therapy consisted of an anti-IL-2 monoclonal antibody for the induction, followed by tacrolimus monotherapy; in the cases of rejection, a course of steroids at decreasing doses was initiated and the therapy was possibly revisited with the introduction of mycophenolate mofetil or, rarely, an mTOR inhibitor. 13…”