title: Small bile duct reconstruction of the caudate lobe in living-related liver transplantation.
abstract: OBJECTIVE
  To justify the technique of biliary reconstruction without mucosa-to-mucosa alignment for reconstructing the caudate lobe bile duct.
  
  
  BACKGROUND
  The use of a left hepatic lobe graft with the caudate lobe (LHGC) has been introduced to resolve the problem of small-for-size grafts in living-related liver transplantation. The authors have found that the LHGCs occasionally have independent openings of the bile duct of the caudate lobe.
  
  
  METHODS
  The graft bile ducts were anastomosed to Roux-en-Y jejunal loops. The main left hepatic ducts were reconstructed in a standard manner. Small bile ducts of the caudate lobe were anastomosed to the intestine without mucosa-to-mucosa alignment, with an external biliary drainage tube, positioned transanastomotically.
  
  
  RESULTS
  In 8 of the 19 patients who received LHGCs, nine bile ducts of the caudate lobe (median 1 mm) were reconstructed. After surgery there was no bile leakage. In five of the eight patients, the tubes were removed a median of 92 days after transplantation. Bile duct dilatation had not been observed at a median of 363 days after surgery.
  
  
  CONCLUSIONS
  The authors consider their technique of biliary reconstruction without mucosa-to-mucosa alignment useful for the safe reconstruction of small bile ducts of the caudate lobe.
authors.affiliation: Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. kubotak@dokkyomed.ac.jp
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Taku
authors.initials: T
authors.lastname: Aoki
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery*; D004108:Dilatation, Pathologic; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D013536:Suture Techniques