Duct-to-duct biliary anastomosis with a "corner-saving suture" technique in living-related liver transplantation.
OBJECTIVE
Biliary complications after living-related liver transplantation (LRLT) remain a major source of morbidity for recipients. We describe our technique and early results with 32 recipients who underwent LRLT with duct-to-duct anastomoses during the last 2 years.


METHODS
Between January 2003 and December 2004, 50 patients underwent liver transplantation in our center with overall patient and graft survival rate of 86.4% and 86.4%. Of 50 patients, 41 (82.0%; 17 adult and 24 pediatric) underwent LRLT, 32 (78.0%) of whom had duct-to-duct biliary anastomoses with a "corner-saving suture" technique.


RESULTS
Of 32 patients in whom duct-to-duct biliary anastomoses were performed, 4 (12.5%) had an anastomotic leak with 2 eventually developing bile duct strictures within 3 months. One patient required reoperation for a bile leak. All other anastomotic leaks and strictures were treated with percutaneous drainage and balloon dilatation with excellent outcomes. There was no long-term morbidity and no graft loss owing to biliary complications. Seven patients died during follow-up (0.5 to 25 months); 43 are doing well with optimal liver function in the early posttransplantation period.


CONCLUSIONS
According to our early results, we recommend duct-to-duct anastomosis in LRLT when calibration of the ducts show suitable results and when there is no tension on the anastomosis site. Otherwise, Roux-en-Y hepaticojejunostomy should be performed to decrease risk of biliary complications.
Dalgic
A
A
Baskent University, Department of General Surgery, Transplantation Unit, Ankara, Turkey.
Moray
G
G
Emiroglu
R
R
Sozen
H
H
Karakayali
H
H
Boyacioglu
S
S
Bilgin
N
N
Haberal
M
M
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001652:Bile Ducts / Q000601:surgery*; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D020858:Tissue and Organ Harvesting / Q000379:methods