Biliary reconstruction following right adult living donor liver transplantation end-to-end or end-to-side duct-to-duct anastomosis.
OBJECTIVE
Bile duct complications are the modern Achilles' heel of adult-to-adult living donor liver transplantation. A duct-to-duct anastomosis is currently performed in the presence of single graft ducts, while cholangiojejunostomy is used to drain multiple ducts. Our aim is to describe the feasibility of duct-to-duct anastomoses independent of the presence of one or multiple graft bile ducts.


METHODS
The probe technique for right bile duct dissection in donors and a proximal hilar bile duct division in recipients are illustrated. The BARIGA LDLT (biliary anastomosis in right graft for adult living donor liver transplantation recipients) with end-to-side or end-to-end hepatico-hepaticostomy was used in five recipients of right grafts (segments 5-8).


RESULTS
All donors and recipients are doing well; all grafts are functional at 13 months. Duct-to-duct anastomoses to single, double, or triple graft ducts have been performed. Two early anastomotic stenoses at 5 and 10 weeks were successfully treated endoscopically.


CONCLUSIONS
The duct-to-duct anastomosis represents a valid alternative to the standard hepaticojejunostomy for right living donor liver grafts. Using this method, biliary complications can be treated endoscopically. End-to-side or end-to-end BARIGA LDLT has the potential to become a standard method in segmental transplantation, including split liver.
Malagó
Massimo
M
Klinik und Poliklinik für Allgemein-und Transplantationschirurgie, Operatives Zentrum II, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany. massimo.malago@uni-essen.de
Testa
Giuliano
G
Hertl
Martin
M
Lang
Hauke
H
Paul
Andreas
A
Frilling
Andrea
A
Treichel
Ulrich
U
Broelsch
Christoph E
CE
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000592:standards; D019520:Living Donors; D008297:Male; D008875:Middle Aged