title: Hepaticoduodenostomy is an alternative to Roux-en-Y hepaticojejunostomy for biliary reconstruction in live donor liver transplantation.
abstract: BACKGROUND
  A Roux-en-Y hepaticojejunostomy (HJ) is usually performed during live donor liver transplantation (LDLT) when a duct-to-duct reconstruction is not possible. However, direct anastomosis of the bile duct to the duodenum (hepaticoduodenostomy [HD]) is an alternative technique for biliary repair that has been previously used for conventional biliary surgery and at our center for cadaveric liver transplant. We provide the first evidence that HD is an alternative technique for biliary reconstruction in LDLT.
  
  
  METHODS
  We performed a total of 71 LDLT between 2002 and 2008. An end-to-end anastomosis was used in 30 patients. Forty-one patients had a biliary enteric anastomosis in which seven were reconstructed with an HD. Accessory ducts were fashioned into a common duct or implanted into the duodenum separately.
  
  
  RESULTS
  There were no patient deaths or retransplants in a follow-up period that ranged from 90 to 771 days after surgery. One patient was diagnosed with cholangitis that responded to intravenous antibiotics and removal of the stent by endoscopy.
  
  
  CONCLUSIONS
  This preliminary case series suggests that that HD is a feasible alternative to HJ biliary anastomosis when a duct-to-duct anastomosis cannot be performed. HD offers the possible advantage of simple postoperative access to the biliary system by endoscopy and avoids complications caused by HJ bowel anastomosis.
authors: Division of Transplant Surgery, University of Colorado Health Sciences Center, Aurora, CO, USA.
authors: Jeffrey
authors: J
authors: Campsen
authors: Michael A
authors: MA
authors: Zimmerman
authors: Mercedes Susan
authors: MS
authors: Mandell
authors: Michael
authors: M
authors: Wachs
authors: Tom
authors: T
authors: Bak
authors: Lisa
authors: L
authors: Forman
authors: Tracy
authors: T
authors: Steinberg
authors: Igal
authors: I
authors: Kam
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D000714:Anastomosis, Surgical / Q000379:methods; D002758:Cholangiography; D004385:Duodenostomy / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies