Living donor hepatectomies with procedures to prevent biliary complications.
BACKGROUND
Biliary complications in donor hepatectomies are still common, and occur in approximately 5% of the procedures.


METHODS
To evaluate the usefulness of the management and surgical procedures to prevent the biliary complications in donor hepatectomies, a total of 343 donors were retrospectively studied. The clinical and surgical parameters of the donors and the postoperative biliary complications were evaluated.


RESULTS
Fourteen donors had biliary complication (BC) during the follow-up period (4.1%). Donors were divided into 2 groups; donors without BC (non-BC group; n = 329) and donors with BC (BC group; n = 14). Mean peak level of total bilirubin, mean duration of hospital stay after surgery, and medical cost in the BC group were significantly higher than in the non-BC group (p < 0.01). As improved procedures to prevent the BC were established at 2005, including the use of a real-time cholangiography by the C-arm, a minimized dissection of the hepatic vessels, the meticulous closure of the bile duct, and/or the use of Pringle maneuver during the parenchymal transection, the donors were divided into 2 groups before and after these establishments (the early period, n = 173; the later period, n = 170). Refinements in the management and surgical procedures reduced the occurrence of biliary complications from 6.4% during the early period to 1.8% during the later period (p < 0.01), and no biliary complications in the last 69 consecutive donors were observed.


CONCLUSIONS
Technical refinements described in this study might be useful to prevent the occurrence of biliary complications in a donor hepatectomy. It is particularly important to preserve the blood supply for the biliary tract of both the graft and the remnant liver.
Taketomi
Akinobu
A
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. taketomi@surg2.med.kyushu-u.ac.jp
Morita
Kazutoyo
K
Toshima
Takeo
T
Takeishi
Kazuki
K
Kayashima
Hiroto
H
Ninomiya
Mizuki
M
Uchiyama
Hideaki
H
Soejima
Yuji
Y
Shirabe
Ken
K
Maehara
Yoshihko
Y
D000328:Adult; D001659:Biliary Tract / Q000098:blood supply*; D001660:Biliary Tract Diseases / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult