The technical pitfalls of duct-to-duct biliary reconstruction in pediatric living-donor left-lobe liver transplantation: the impact of stent placement.
The feasibility of D-D biliary reconstruction in pediatric LDLT using a left-lobe graft is still controversial. The medical records of 19 pediatric patients (age: four months to 16 yr) were reviewed. The biliary reconstruction was performed in an end-to-end fashion using absorbable sutures. An external biliary tube was placed into the bile duct through the anastomotic site (n = 10) and not through the anastomotic site (n = 4). An external tube was not used in five patients. The median follow-up was 4.7 yr. Nine patients had 11 biliary complications (leakage, n = 2; stricture, n = 7; stricture with leakage, n = 2). Due to biliary complications, conversion to an R-Y was required in five patients, and four patients required radiological or endoscopic management. The patients younger than one yr of age required conversion to R-Y within one wk after LDLT. The analysis of factors related to biliary complications revealed that the use of a trans-anastomotic biliary tube was the only significant factor to avoid biliary complications. In conclusion, D-D biliary reconstruction in LDLT using a left-lobe graft is feasible in selected cases, though it remains challenging. The use of a trans-anastomotic biliary tube is important to avoid biliary complications.
Sakamoto
Seisuke
S
Department of Hepatobiliary Pancreatic Surgery and Transplantation, Kyoto University, Faculty of Medicine, Kyoto, Japan. sseisuke@kuhp.kyoto-u.ac.jp
Egawa
Hiroto
H
Ogawa
Kohei
K
Ogura
Yasuhiro
Y
Oike
Fumitaka
F
Ueda
Mikiko
M
Yazumi
Shujiro
S
Shibata
Toshiya
T
Takada
Yasutsugu
Y
Uemoto
Shinji
S
D000293:Adolescent; D001652:Bile Ducts / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008099:Liver / Q000033:anatomy & histology / Q000473:pathology; D008107:Liver Diseases / Q000601:surgery* / Q000628:therapy*; D016031:Liver Transplantation / Q000295:instrumentation* / Q000379:methods*; D019520:Living Donors; D008297:Male; D019919:Prosthesis Implantation; D016896:Treatment Outcome