title: Duct-to-duct biliary reconstruction in adult-to-adult living donor liver transplantation.
abstract: In living donor liver transplantation (LDLT), Roux-en-Y hepaticojejunostomy has been a standard technique for biliary reconstruction because the majority had been pediatric patients with biliary atresia. Adult-to-adult LDLT using the right lobe graft has recently been developed and we introduced duct-to-duct biliary reconstruction (hepaticohepaticostomy) in such cases. The aim of this study is to evaluate the feasibility of this procedure in adult-to-adult LDLT. From August 2000 to October 2001, five patients underwent adult-to-adult LDLT using the right hepatic lobe and were followed for more than 6 months at our institution. All patients underwent duct-to-duct biliary reconstruction (single hepaticohepaticostomy in one, multiple in four). For the grafts with multiple bile ducts, various techniques were used for reconstruction. In all patients, oral intake could be started early after the operation, and biliary leakage was not encountered. One patient developed two episodes of acute cholangitis who later developed biliary anastomosis stricture which required percutaneous dilatation at 11 months postop. However, otherwise, there were no infectious complications postoperatively. We conclude duct-to-duct biliary reconstruction is feasible and effective in adult-to-adult LDLT.
authors.affiliation: Department of Surgery II, Faculty of Medicine, Nagasaki University, Nagasaki, Japan.
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Takatsuki
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
authors.forename: Sadayuki
authors.initials: S
authors.lastname: Okudaira
authors.forename: Jyunichiro
authors.initials: J
authors.lastname: Furui
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000601:surgery*; D005240:Feasibility Studies; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors