title: Feasibility of duct-to-duct biliary reconstruction in left-lobe adult-living-donor liver transplantation.
abstract: A Roux-en-Y choledochojejunostomy (CDJ) has been the sole method of choice for the reconstruction of the bile duct in living-donor liver transplantation (LDLT) using left-lobe grafts. In this study, we evaluated the feasibility of duct-to-duct (DD) biliary reconstruction in adult-to-adult LDLT using left-lobe grafts. Between October 1996 and October 2001, 46 adult-to-adult LDLTs using the left lobe were performed at our institution. The DD biliary reconstruction (hepaticocholedochostomy) over a T-tube was performed for seven of the last nine recipients (DD group, n=7), whereas the conventional Roux-en-Y CDJ was used for the remaining cases (CDJ group, n=39). The technical problems and the incidence of biliary complications were compared between the groups. Bile leakage developed in only 1 of 7 (14%) in the DD group (leakage from a T-tube exit site), whereas it occurred in 8 of 39 (20%) in the CDJ group. Up to now, no patients from the DD group developed anastomotic stricture, whereas twelve (30.7%) patients from the CDJ group did. Other complications included bleeding from the Roux-en-Y jejunojejunostomy (n=1) and anastomotic occlusion caused by an internal stent (n=1), and both complications were associated with CDJ. In conclusion, DD anastomosis is a simple and viable option for biliary reconstruction in left-lobe LDLTs. A long-term follow-up, especially regarding the incidence of biliary stricture, is thus warranted in such patients.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. ysoejima@surg2.med.kyushu-u.ac.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Suehiro
authors.forename: Keiji
authors.initials: K
authors.lastname: Kishikawa
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Minagawa
authors.forename: Shoji
authors.initials: S
authors.lastname: Hiroshige
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Satoko
authors.initials: S
authors.lastname: Shiotani
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Keizo
authors.initials: K
authors.lastname: Sugimachi
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures