title: Eversion Technique to Prevent Biliary Stricture After Living Donor Liver Transplantation in the Universal Minimal Hilar Dissection Era.
abstract: BACKGROUND
  Biliary anastomosis stricture (BAS) is still among the major concerns after living donor liver transplantation (LDLT), even after the technical refinements including the universal use of the blood flow-preserving hilar dissection technique. The aim of this study is to investigate what are still the factors for BAS after LDLT.
  
  
  METHODS
  An analysis of 279 adult-to-adult LDLT grafts (left lobe, n = 161; right lobe, n = 118) with duct-to-duct biliary reconstruction, since the universal application of minimal hilar dissection technique and gradual introduction of eversion technique, was performed.
  
  
  RESULTS
  There were 39 patients with BAS. Univariate analysis showed that a right lobe graft (P = 0.008), multiple bile ducts (P < 0.001), ductoplasty (P < 0.001), not using the eversion technique (P = 0.004) and fewer biliary stents than bile duct orifices (P = 0.002) were among the factors associated with BAS. The 1-year and 5-year BAS survival rates were 17.7% and 21.2% in the noneversion group (n = 134), and 6.2% and 7.9% in the eversion group (n = 145), respectively (P = 0.002). The perioperative factors including graft biliary anatomy were not different between everted (n = 134) and noneverted (n = 145) patients.
  
  
  CONCLUSIONS
  The application of eversion technique under minimal hilar dissection technique could be a key for preventing BAS in duct-to-duct biliary reconstruction in LDLT.
authors.affiliation: 1 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Tomonari
authors.initials: T
authors.lastname: Shimagaki
authors.forename: Junji
authors.initials: J
authors.lastname: Kawasaki
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Norifumi
authors.initials: N
authors.lastname: Harimoto
authors.forename: Shinji
authors.initials: S
authors.lastname: Itoh
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002779:Cholestasis / Q000209:etiology / Q000517:prevention & control*; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007564:Japan; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome