title: Duct-to-duct biliary reconstruction in living donor liver transplantation utilizing right lobe graft.
abstract: OBJECTIVE
  To assess the feasibility and safety of duct-to-duct biliary anastomosis for living donor liver transplantation (LDLT) utilizing the right lobe.
  
  
  BACKGROUND
  Biliary tract complications remain one of the most serious problems after liver transplantation. Roux-en-Y hepaticojejunostomy has been a standard procedure for biliary reconstruction in LDLT with a partial hepatic graft. However, end-to-end choledochocholedochostomy is the technique of choice for biliary reconstruction and yields a more physiologic bilioenteric continuity than can be achieved with Roux-en-Y hepaticojejunostomy. The authors performed right lobe LDLT with end-to-end duct-to-duct biliary anastomosis, and this study assessed retrospectively the relation between the manner of reconstruction and complications.
  
  
  METHODS
  Between July 1999 and December 2000, 51 patients (11-67 years of age) underwent 52 right lobe LDLTs with duct-to-duct biliary reconstruction and remained alive more than 1 month after their transplantation. Interrupted biliary anastomosis was performed for 24 transplants and the continuous procedure was used for 28. A biliary tube was inserted downward into the common bile ducts through the recipient's cystic duct in 16 transplants (cystic drainage), or a biliary stent tube was pushed upward into the anastomosis through the cystic duct in four transplants (cystic stent), or upward into the anastomosis through the wall of the common bile duct in 31 transplants (external stent).
  
  
  RESULTS
  Biliary anastomotic procedures consisted of 34 single end-to-end anastomoses, 11 double end-to-end anastomoses, and 7 single anastomoses for double hepatic ducts. Overall, 5 patients developed leakage (9.6%) and 12 patients suffered stricture (23.0%). For biliary anastomosis with interrupted suture, the incidence of stricture was significantly higher in the cystic drainage group (53.3%, 8/15) than in the stent group consisting of cystic stent and external stent (0%, 0/8). While the respective incidences of leakage and stricture were 20% and 53.3% for intermittent suture with a cystic drainage tube (n = 15), they were 7.7% and 15.4% for a continuous suture with an external stent (n = 26). There was a significant difference in the incidence of stricture.
  
  
  CONCLUSIONS
  Duct-to-duct reconstruction with continuous suture combined with an external stent represents a useful technique for LDLT utilizing the right lobe, but biliary complications remain significant.
authors.affiliation: Department of Transplantation and Immunology, Faculty of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Ishiko
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Taro
authors.initials: T
authors.lastname: Nakamura
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Oike
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaihara
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kiuchi
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Inomata
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D001652:Bile Ducts / Q000098:blood supply / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents; D013536:Suture Techniques; D016896:Treatment Outcome