Biliary complications in adult living donor liver transplantation with duct-to-duct hepaticocholedochostomy or Roux-en-Y hepaticojejunostomy biliary reconstruction.
BACKGROUND
The aim of this study was to compare the incidence of biliary complications after adult living donor liver transplantation (ALDLT) with Roux-en-Y hepaticojejunostomy (R-Y HJ) or duct-to-duct hepaticocholedochostomy (D-D HC).


METHODS
Biliary complications were reviewed in 20 consecutive ALDLT recipients surviving more than 1 month, including 10 patients who underwent R-Y HJ and 10 patients who underwent D-D HC reconstructions.


RESULTS
Ten biliary complications were seen in 8 patients (40%) from the study group. Specifically, 1 case of biliary leakage and 1 case of biliary hemorrhage were observed in the R-Y HJ group (20%), and 2 biliary leakages, 4 biliary strictures, and 2 C-tube related biliary leakages were seen in 6 patients from the D-D HC group (60%). Three of the 5 patients (60%) who underwent right lobe graft ALDLTs experienced biliary stricture. All cases of biliary leakage and biliary hemorrhage were stopped spontaneously by continuous drainage. Three patients in the D-D HC group with anastomotic strictures were successfully treated with percutaneous interventions. Only 1 patient with anastomotic stricture in the D-D HC group with left lobe graft required intrahepatic R-Y HJ reanastomosis. Two cases of C-tube related biliary leakages were treated with endoscopic management.


CONCLUSIONS
Biliary complications such as anastomotic strictures were common in the D-D HC group rather than in the R-Y HJ group. D-D HC reconstruction should be applied cautiously, especially in the right lobe graft ALDLT cases.
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Shigeyuki
S
Kawachi
Motohide
M
Shimazu
Go
G
Wakabayashi
Ken
K
Hoshino
Minoru
M
Tanabe
Masashi
M
Yoshida
Yasuhide
Y
Morikawa
Masaki
M
Kitajima
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical; D001660:Biliary Tract Diseases / Q000209:etiology*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D003135:Common Bile Duct / Q000601:surgery; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D007583:Jejunum / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male