title: Technical refinements of bile duct division in living donor liver surgery.
abstract: OBJECTIVE
  In spite of the great risk involved, the donor bile duct division procedure has not been thoroughly addressed in the literature. The purpose of this study is to show the appropriate approach to bile duct division in living donor hepatectomy.
  
  
  METHODS
  Of 87 living donor liver surgeries, we performed bile duct division by marking the cutting point using a small vascular clip under ordinary cholangiography in the first 37 patients, while the current procedure was used in 50 patients by encircling the cutting point using a radiopaque marker filament under real-time C-arm cholangiography.
  
  
  RESULTS
  Regarding the procurement of the 51 right lobe grafts, the incidence of multiple bile ducts in the graft was significantly reduced by our novel procedure [20/28 (71%) vs. 7/23 (30%), P < 0.01, Fisher's test]. Overall, there were no biliary strictures after surgery in any of the donors, with a median follow-up period of 43 months (range 8-136).
  
  
  CONCLUSIONS
  Our procedure of bile duct division in living liver donor surgery enabled us to avoid the biliary stricture while cutting the bile duct of the donor with great accuracy.
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. takapon@net.nagasaki-u.ac.jp
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Takatsuki
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
authors.forename: Kosho
authors.initials: K
authors.lastname: Yamanouchi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hidaka
authors.forename: Akihiko
authors.initials: A
authors.lastname: Soyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001652:Bile Ducts / Q000601:surgery*; D002758:Cholangiography; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*; D055815:Young Adult