title: Timing of Roux-en-Y limb reconstruction for pediatric live donor liver transplantation.
abstract: BACKGROUND
  Roux-en-Y (R-Y) hepaticojejunostomy is usually accepted as the standard method of choice for biliary reconstruction in pediatric cases though the potential risks for gastrointestinal complications are higher. In this study, we examined gastrointestinal complications in pediatric patients by comparing two different strategies of R-Y reconstruction with respect to the portal clampage time.
  
  
  METHODS
  Forty-three pediatric recipients who underwent Live Donor Liver Transplantation with R-Y for biliary reconstruction between March 2001 and December 2006 in our transplantation center were divided into two groups regarding the time of dissection and creation of the roux limb. R-Y limb reconstruction was performed before clampage of the portal vein in group A-preclampage group. In group B, because of prolonged catheterization period, R-Y limb was reconstructed after implantation of the graft (Group B- postclampage group).
  
  
  RESULTS
  Overall, seven patients (16%) had gastrointestinal bleeding in the postoperative period, all in group B (0/20 vs. 7/23, P<0.01). One of those three cases who were diagnosed after endoscopy and one another were performed surgical treatment. Although remaining three cases had multiple bleeding episodes but no diagnostic findings by endoscopic/colonoscopic interventions, conservative treatment was successful and therefore, plausible R-Y limb bleeding was considered for these cases. The timing of removal of nasogastric tube and postoperative oral intake were also significantly earlier (P<0.01) in Group A than in Group B.
  
  
  CONCLUSIONS
  In Live Donor Liver Transplantation, if recipient team may have enough time until the donor team got ready for the recovery of the graft, dissection and preparation of the R-Y limb should be performed. This approach can be helpful to avoid gastrointestinal complications due to the reconstruction of the R-Y limb.
authors.affiliation: Ege University School of Medicine, Organ Transplantation and Research Center, Izmir, Turkey. drunalaydin@gmail.com
authors.forename: Unal
authors.initials: U
authors.lastname: Aydin
authors.forename: Pinar
authors.initials: P
authors.lastname: Yazici
authors.forename: Hasan
authors.initials: H
authors.lastname: Yuksekkaya
authors.forename: Cigdem
authors.initials: C
authors.lastname: Arikan
authors.forename: Sema
authors.initials: S
authors.lastname: Aydogdu
authors.forename: Murat
authors.initials: M
authors.lastname: Zeytunlu
authors.forename: Murat
authors.initials: M
authors.lastname: Kilic
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000601:surgery; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies