Biliary reconstruction in living donor liver transplantation: technical invention and risk factor analysis for anastomotic stricture.
BACKGROUND
Bile duct complications especially biliary stricture remains a major cause of morbidity influencing the postoperative course in living donor liver transplantation (LDLT). The objectives of this study were to investigate the outcome of biliary reconstruction using "open-up" anastomotic technique and to clarify the risk factors for biliary stricture after LDLT.


METHODS
We retrospectively analyzed data of 83 consecutive adult patients who underwent LDLT between 1999 and 2007. Hepaticojejunostomy was conducted in 22 patients and duct-to-duct anastomosis in 61 patients. The "open-up" anastomotic technique was applied uniformly for biliary reconstruction.


RESULTS
The mean follow-up period after LDLT was 2.7+/-2.1 years (range, 0.01-7.52). Of the 83 recipients, six (7.2%) developed biliary strictures (four at anastomotic site and two at multiple intrahepatic sites), and one (1.2%) developed biliary leakage after hepaticojejunostomy. Risk factor analysis identified the diameter of donor bile duct and the use of right lateral sector as significant risk factors for biliary stricture at the anastomosis.


CONCLUSIONS
Care should be taken when anastomosing a small bile duct of the donor graft or right lateral sector graft in LDLT because of the associated high incidence of biliary stenosis. Our technique, including the "open-up" procedure, ensures quality control for bile duct reconstruction and a better outcome after LDLT.
Marubashi
Shigeru
S
Department of Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. smarubashi@gesurg.med.osaka-u.ac.jp
Dono
Keizo
K
Nagano
Hiroaki
H
Kobayashi
Shogo
S
Takeda
Yutaka
Y
Umeshita
Koji
K
Monden
Morito
M
Doki
Yuichiro
Y
Mori
Masaki
M
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology*; D005704:Gallbladder / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors