title: Bile duct reconstruction by a young surgeon in living donor liver transplantation using right liver graft.
abstract: Biliary strictures and bile leaks account for the majority of biliary complications after living donor liver transplantation (LDLT). The aim of this study was to examine differences in biliary complications after adult LDLTs were performed by an experienced senior surgeon and an inexperienced junior surgeon. Surgeries included bile duct reconstruction after adult LDLT using a right liver graft, and risk factors for biliary stricture were identified. We retrospectively reviewed the medical records of 136 patients who underwent LDLT in order to identify patients who developed biliary complications. The senior surgeon performed 102 surgeries and the junior surgeon performed 34 surgeries. The proportion of patients with biliary stricture was similar between the senior and the junior surgeons (27.5% vs 26.5%; P = 0.911). However, the incidence of biliary leakage was higher in patients of the junior surgeon than in those of the senior surgeon (23.5% vs 2.9%; P = 0.001). The frequency of percutaneous drainage was also higher for the junior surgeon than the senior surgeon because of the junior surgeon's high leakage rate of the drainage. When the junior surgeon performed bile duct anastomosis, biliary leakage occurred in 7 patients between the 11th and 20th cases. However, biliary leakage occurred in only 1 case thereafter. Bile duct reconstruction performed by beginner surgeons in LDLT using right lobe grafts should be cautiously monitored and observed by a senior surgeon until an inexperienced junior surgeon has performed at least 20 cases, because of the high incidence of biliary leakage related to surgeon's inexperience in bile duct reconstructions in LDLT.
authors.affiliation: Department of Surgery, Samsung Medical Center (JMK, WC, CHDK, J-WJ, JBP, SJK, SKL); and Department of Anesthesiology and Pain Medicine (JSK, MSG, GSK), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jong Man
authors.initials: JM
authors.lastname: Kim
authors.forename: Wontae
authors.initials: W
authors.lastname: Cho
authors.forename: Choon Hyuck David
authors.initials: CHD
authors.lastname: Kwon
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Joh
authors.forename: Jae Berm
authors.initials: JB
authors.lastname: Park
authors.forename: Justin Sangwook
authors.initials: JS
authors.lastname: Ko
authors.forename: Mi Sook
authors.initials: MS
authors.lastname: Gwak
authors.forename: Gaab Soo
authors.initials: GS
authors.lastname: Kim
authors.forename: Sung Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Suk-Koo
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000601:surgery*; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult