title: In adult-to-adult living donor liver transplantation hepaticojejunostomy shows a better long-term outcome than duct-to-duct anastomosis.
abstract: Roux-en-Y hepaticojejunostomy (RYHJ) has been the standard biliary reconstruction in adult-to-adult living donor liver transplantation (ALDLT). Recently, duct-to-duct anastomosis (DD) has been introduced. This study compared the outcomes of RYHJ and DD. For 4 years, 74 recipients underwent ALDLT and were followed up for at least 2 years. The patients were divided into three groups, RYHJ group (n = 18), DD with a stent (DD + S) group (n = 35), and DD without a stent (DD - S) group (n = 21). Overall, biliary complications were developed in 32.4% patients. The biliary complication rate was 11.1%, 48.5% and 33.3% in RYHJ, DD + S and DD - S groups, respectively (P = 0.047). Bile leaks occurred in 28.5% of DD + S group. The incidence of biliary stricture was 5.3%, 20.2% and 28.6% in RYHJ, DD + S and DD - S group, respectively. Most complications (83.3%) were resolved nonsurgically. RYHJ has a better long-term outcome than DD in ALDLT. Subgroup analysis of DD group showed that DD - S group had no bile leaks, but still had a higher incidence of bile duct strictures. However, because this study was a retrospective review there are limitations in analyzing the data and confirming the conclusion. A randomized-prospective study will be needed to confirm these findings.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Chongno-Gu, Seoul, Korea.
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Jai Young
authors.initials: JY
authors.lastname: Cho
authors.forename: Choon Hyuck
authors.initials: CH
authors.lastname: Kwon
authors.forename: Kuhn Uk
authors.initials: KU
authors.lastname: Lee
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures; D002779:Cholestasis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007583:Jejunum / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome