title: Outcome of routine use of microsurgical biliary reconstruction in pediatric living donor liver transplantation.
abstract: OBJECTIVE
  Microsurgical techniques, initially used for hepatic artery reconstruction, have been extended to biliary reconstruction to decrease biliary complications. The routine use of microsurgical biliary reconstruction in pediatric living donor liver transplantation (LDLT) has not been elucidated.
  
  
  METHODS
  Sixty-seven pediatric patients underwent primary LDLT. All biliary reconstructions were performed by a single microsurgeon using microsurgical techniques. A biliary stent was not used. The minimum follow-up was 12 months. Thirty-four patients had a minimum follow-up of 36 months. The outcomes of those who underwent microsurgical biliary reconstruction were compared with the outcomes of a cohort of 67 patients who underwent conventional biliary reconstruction.
  
  
  RESULTS
  The demographical and clinical profiles of the two groups were not significantly different. There were 5 anastomotic complications in the conventional and 2 anastomotic complications in the microsurgical reconstruction groups. All complications developed within 90 days after transplant. There were no late biliary complications. Further analysis showed that conventional reconstruction increased the risk of biliary complications by 2.4 times (relative risk: 2.42; attributable risk: 4.5).
  
  
  CONCLUSIONS
  The routine use of microsurgical biliary reconstruction in pediatric LDLT is a technical innovation that led to decreased anastomotic biliary complications.
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan. clchen@cgmh.org.tw
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Allan M
authors.initials: AM
authors.lastname: Concejero
authors.forename: Tsan-Shiun
authors.initials: TS
authors.lastname: Lin
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Lin
authors.forename: Yuan-Cheng
authors.initials: YC
authors.lastname: Chiang
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Shih-Ho
authors.initials: SH
authors.lastname: Wang
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.forename: Yueh-Wei
authors.initials: YW
authors.lastname: Liu
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008866:Microsurgery / Q000379:methods*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D013624:Taiwan; D016896:Treatment Outcome