Duct-to-duct biliary reconstruction in selected cases in pediatric living-donor left-lobe liver transplantation.
The feasibility of D-D biliary reconstruction in pediatric LDLT using left-lobe graft has been discussed in few reports. The use of a trans-anastomotic biliary tube seemed to be the favorable method to avoid the complications according to these reports. We had performed left-lobe LDLT for seven pediatric cases and D-D was done originally. Three cases were converted to R-Y hepaticojejunostomy due to radical resection of hepatoduodenal ligament (n = 1) and severe kinking of D-D (n = 2). Four cases received D-D using 6-0 PDS interrupted sutures without external stent tube. One D-D case died of intra-cerebral hemorrhage 10 days after operation with a functioning graft. There was one biliary leakage in a D-D patient who required PTCD stent for 4 months without any sequale. From our limited experience, D-D biliary reconstruction without external stent tube in left-lobe LDLT is feasible in certain pediatric cases having normal extra-hepatic bile ducts. In smaller recipient with larger graft, the use of a trans-anastomotic biliary tube can prevent anastomotic kinking although we suggest R-Y biliary reconstruction is better for this condition.
Liu
Chinsu
C
Division of Pediatric Surgery, Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan. csliu@vghtpe.gov.tw
Loong
Che-Chuan
CC
Hsia
Cheng-Yuan
CY
Peng
Cheng-Kang
CK
Tsai
Hsin-Lin
HL
Tsou
Mei-Yung
MY
Wei
Choufu
C
D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D001652:Bile Ducts / Q000601:surgery*; D002543:Cerebral Hemorrhage; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008099:Liver / Q000033:anatomy & histology* / Q000473:pathology; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D010372:Pediatrics / Q000379:methods; D015607:Stents; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome