title: En Bloc Hilar Dissection of the Right Hepatic Artery in Continuity with the Bile Duct: a Technique to Reduce Biliary Complications After Adult Living-Donor Liver Transplantation.
abstract: OBJECTIVE
  Techniques that preserve the right hepatic artery and the common bile duct in continuity during the dissection may be associated with lower rates of biliary complications in living-donor liver transplants. This study sought to determine whether en bloc hilar dissections were associated with fewer biliary complications in living-donor liver transplants.
  
  
  METHODS
  This was a retrospective review of 41 adult LDLTs performed in a single, liver transplant center between February 2007 and September 2014. The primary outcome of interest was the occurrence of at least one of the following biliary complications: anastomotic leak, stricture, or biloma. The primary predictor of interest was the hilar dissection technique: conventional hilar dissection vs. en bloc hilar dissection.
  
  
  RESULTS
  A total of 41 LDLTs were identified, 24 had a conventional, and 17 an en bloc hilar biliary dissection. The occurrence of any biliary complication was significantly more common in the conventional hilar dissection group compared to the en bloc hilar dissection group (66.7 vs. 35.3%, respectively, p = 0.047). In particularly, anastomotic strictures were significantly more common in the conventional hilar dissection group compared to the en bloc hilar dissection group (54.2 vs. 23.5%., respectively, p = 0.049).
  
  
  CONCLUSIONS
  En bloc hilar dissection technique may decrease biliary complication rates in living donor liver transplants.
authors.affiliation: Division of Transplantation, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Dulles, Philadelphia, PA, 19104, USA. samirski11@yahoo.com.
authors.forename: Samir
authors.initials: S
authors.lastname: Abu-Gazala
authors.affiliation: Division of Transplantation, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Dulles, Philadelphia, PA, 19104, USA.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Olthoff
authors.affiliation: Division of Transplantation, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Dulles, Philadelphia, PA, 19104, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Goldberg
authors.affiliation: Division of Transplantation, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Dulles, Philadelphia, PA, 19104, USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Shaked
authors.affiliation: Division of Transplantation, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Dulles, Philadelphia, PA, 19104, USA.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Abt
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D003135:Common Bile Duct / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Biliary complications; End-stage liver disease—ESLD; Living donor liver transplantation—LDLT