Ligation and cut as a method for bile duct division in living donor right hepatectomy.
The importance of bile duct division cannot be overemphasized in living donor surgery. Ligation and cut (LC) as a method for bile duct division in living donor right hepatectomy (LDRH) has never been reported. The purpose of this study was to introduce the LC method of bile duct division in LDRH. All LDRH donors were identified through a prospectively maintained database at the authors' institution between September 2009 and March 2013, and the 2 methods, LC and cut and oversewing (CO), were compared both in terms of donor and recipient outcomes of right lobe living donor liver transplantation. In the LC method, after complete parenchymal transection, the right hepatic duct was dissected in the Glisson's sheath and ligated just at the right side of the confluence, and then the right side of the ligature was cut. The LC and CO methods were performed in 109 and 134 donors, respectively. Bile duct division time (P < 0.001) and operative time (P < 0.001) were significantly shorter in the LC group than in the CO group. With a median follow-up of 60.2 months, biliary complication rate was lower in the LC group than in the CO group (0% versus 5.2%; P = 0.01), but with no significant difference between the recipient groups. All donors made a complete recovery. In conclusion, the bile ducts of living donors can be dissected safely from the Glisson's sheath, and the LC method facilitates bile duct division and has a lower incidence of biliary complication in LDRH without compromising the recipient outcomes. Liver Transplantation 23 448-456 2017 AASLD.
Organ Transplantation Center, Center for Liver Cancer, National Cancer Center, Ilsandong-gu, Goyang-si Gyeonggi-do, South Korea.
Seong Hoon
SH
Kim
Organ Transplantation Center, Center for Liver Cancer, National Cancer Center, Ilsandong-gu, Goyang-si Gyeonggi-do, South Korea.
Eung Chang
EC
Lee
Organ Transplantation Center, Center for Liver Cancer, National Cancer Center, Ilsandong-gu, Goyang-si Gyeonggi-do, South Korea.
Seung Duk
SD
Lee
Organ Transplantation Center, Center for Liver Cancer, National Cancer Center, Ilsandong-gu, Goyang-si Gyeonggi-do, South Korea.
Sang Jae
SJ
Park
D000293:Adolescent; D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D049448:Cholangiopancreatography, Magnetic Resonance; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D008026:Ligation; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult