title: Is microsurgical technique useful in biliary reconstruction of living donor liver transplantation?
abstract: BACKGROUND
  Biliary reconstruction remains the "Achilles' heel" of living donor liver transplantation (LDLT). In the last decades, the technical aspects of biliary reconstruction have been debated for their impact on biliary complications in LDLT. A microsurgical technique in biliary reconstruction is more attractive.
  
  
  METHODS
  From December 2010 to June 2011, 15 primary LDLTs underwent duct-to-duct biliary reconstruction using a microscopic technique. External stents were inserted in all patients. All procedures were performed under a microscope by a single transplant microsurgeon.
  
  
  RESULTS
  The time consumed for bile duct reconstruction using the microscopic technique was 35 minutes. There were 8 grafts with a single bile duct orifice and seven with two orifices. The average duct size was 3 mm in patients with two orifices and 5 mm in those with a single orifice. There was no bile leak or biliary stricture associated with the biliary reconstruction over a median 5-month follow-up. There were two cases of bile leakage from the cut hepatic surface.
  
  
  CONCLUSIONS
  The microscopic technique reduced early biliary complications. However, further technical advances are needed to decrease the time consumptions for the procedure.
authors.affiliation: Division of Hepatobiliary and Transplantation Surgery, Department of Surgery, Catholic University of Daegu, College of Medicine, Daegu, Republic of Korea.
authors.forename: J D
authors.initials: JD
authors.lastname: Kim
authors.forename: Y S
authors.initials: YS
authors.lastname: Han
authors.forename: D L
authors.initials: DL
authors.lastname: Choi
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001649:Bile Duct Diseases / Q000209:etiology; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000295:instrumentation; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation; D056910:Republic of Korea; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome