title: Evolution of a reliable biliary reconstructive technique in 400 consecutive living donor liver transplants.
abstract: BACKGROUND
  Biliary complications (BCs) are a major cause of morbidity and mortality after living donor liver transplantation (LDLT). They occur because the graft hepatic ducts are often small, thin walled, multiple, and may become ischemic during transection.
  
  
  METHODS
  Of the 460 LDLTs done at our center before November 2009, the first 402 partial liver grafts had at least 3 months of follow-up. In the first 158, conventional hepatic duct isolation was used in the donor (group C). In the last 244 cases, the complete hilar plate and Glissonian sheath approach (HPGS) was used (group H). We compared the incidence and outcomes of BCs in the 2 groups.
  
  
  RESULTS
  The rate of BC was significantly lower in group H (5.3%) than in group C (15.8%, p = 0.000). The incidence of early (within 3 months of transplant) BCs was similarly significantly lower in group H (3.3%) than in group C (13.2%, P=0.000). The incidence of late BCs in the 145 patients in group H who had completed at least 12 months of follow-up was 2.8%.The proportion of BCs needing surgical correction was much higher in group C (44%) than in group H (7.7%, p = 0.022).
  
  
  CONCLUSIONS
  By providing a graft with a well-vascularized hepatic duct or ducts with a sheath of supporting tissue that holds sutures well, the HPGS approach minimizes the incidence and severity of BCs in LDLT.
authors.affiliation: Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Arvinder Singh
authors.initials: AS
authors.lastname: Soin
authors.forename: Vinay
authors.initials: V
authors.lastname: Kumaran
authors.forename: Amit Nath
authors.initials: AN
authors.lastname: Rastogi
authors.forename: Ravi
authors.initials: R
authors.lastname: Mohanka
authors.forename: Naimish
authors.initials: N
authors.lastname: Mehta
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Saigal
authors.forename: Neeraj
authors.initials: N
authors.lastname: Saraf
authors.forename: Neelam
authors.initials: N
authors.lastname: Mohan
authors.forename: Samiran
authors.initials: S
authors.lastname: Nundy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome