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Duct-to-duct biliary reconstructions and complications in 100 living donor liver transplantations.

Kim, BW; Bae, BK; Lee, JM; Won, JH; Park, YK; Xu, WG; Wang, HJ; Kim, MW
Transplantation proceedings, 41(5):1749-1755, 2009
Journal Title
Transplantation proceedings
OBJECTIVE: We evaluated the risk factors for biliary complications and surgical procedures for duct-to-duct reconstructions in adult living donor liver transplantation (LDLT).

PATIENTS AND METHODS: From February 2005 to March 2008, we performed 100 cases of adult LDLT with duct-to-duct biliary reconstruction, using 64 right lobe grafts, 33 left lobe grafts, and 3 right lateral grafts. We employed 4 types of duct-to-duct procedures: all interrupted 6-0 Prolene suture (group 1, n = 9); continuous posterior and interrupted anterior wall 6-0 Prolene suture (group 2, n = 49); all continuous 7-0 Prolene suture (group 3, n = 26); and all continuous 7-0 Prolene suture with external stent (group 4, n = 16). Biliary complications were defined as an anastomosis stricture or a leakage.

RESULTS: Thirty-four patients experienced biliary complications during the follow-up period (median, 27 months). The incidence of stricture was 27% and that of leakage, 8%. There were no perioperative, intraoperative, or anatomic risk factors for biliary complications, except the type of duct-to-duct procedure. Group 1 and 2 patients showed higher incidences of biliary strictures than groups 3 and 4 (43.1% vs 4.7%; P = .00). Group 3 patients experienced a higher incidence of bile leakage than the other groups (23.1% vs 2.7%; P = .004).

CONCLUSIONS: The type of biliary reconstruction is a factor affecting biliary complications following duct-to-duct anastomosis in LDLT. Duct-to-duct biliary anastomosis with 7-0 monofilament suture and a small external stent is a feasible procedure in LDLT that significantly reduces the incidence of biliary complications.
MeSH terms
AdultAgedAnastomosis, Surgical/methods*Bile Ducts/pathologyBile Ducts/surgery*FemaleGallbladder/surgery*HumansLiver Transplantation/adverse effects*Living Donors*MaleMiddle AgedPatient SelectionPostoperative Complications/epidemiology*Reconstructive Surgical Procedures/methods*Retrospective StudiesRisk Factors
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
AJOU Authors
김, 봉완배, 병구원, 제환왕, 희정김, 명욱
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