title: Intraoperative real-time cholangiography and C-tube drainage in donor hepatectomy reduce biliary tract complications.
abstract: BACKGROUND
  In living-donor liver transplantation, biliary tract complications are a serious problem for recipients and donors.
  
  
  METHODS
  We applied intraoperative real-time cholangiography using a C-arm and/or C-tube drainage to reduce biliary tract complications in donor hepatectomy. From 2003 to 2010, intraoperative real-time cholangiography and C-tube drainage was applied to 39 and 19 donor cases, respectively. Fifteen donor cases had both procedures.
  
  
  RESULTS
  We confirmed the division line of the hepatic duct by visualizing a stricture on the monitor of the C-arm by pulling a thread and dissecting the proper site of the bile duct. The number of hepatic ducts of the graft to be anastomosed was 1 in 11 cases and 2 or 3 in 8 of the 19 cases without intraoperative real-time cholangiography, and it was 1 in 32 cases and 2 in 7 of the 39 cases with intraoperative real-time cholangiography. Bile leakage from the resection occurred in seven donors without, and in none of those with, C-tube drainage.
  
  
  CONCLUSIONS
  In living-donor liver transplantation, intraoperative real-time cholangiography enables effective determination of the precise division line of the hepatic duct. Moreover, C-tube drainage is effective for reducing bile leakage from the resected surface of the liver of donors.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. tochiai@koto.kpu-m.ac.jp
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Koji
authors.initials: K
authors.lastname: Inoue
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Yukihito
authors.initials: Y
authors.lastname: Kokuba
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000517:prevention & control*; D002758:Cholangiography; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult