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Technique of bile duct reconstruction and management of biliary complications in right lobe living donor liver transplantation.

Abstract：

:From December 1999 to January 2002, 50 right lobe living donor liver transplantations were performed. The donor operations included an intraoperative cholangiography to elicit variations in bile duct anatomy. The biliary reconstruction was done whenever possible as an end-to-end microanastomosis of the donor right hepatic duct with the recipient's bile duct. As a result of the early segmental branching of the donor biliary tree, two segment bile ducts had to be anastomosed in 20 patients and three segment bile ducts in three patients. In 12 patients, a Roux-en-Y hepaticojejunostomy was performed. All anastomoses were drained externally. We observed two leakages at the resection surface which could be treated successfully by an external drainage. Six leaks occurred at the site of end-to-end biliary anastomoses. Twice the problem could be conservatively solved placing a stent percutaneously. In two patients a hepaticojejunostomy was performed after a bile duct necrosis. In two patients with an anastomotic leak, occurring 3 d, respectively, 3 month after the original transplantation, the bile duct could be directly reconstructed over a T-tube. Two anastomotic stenoses were observed, one in combination with a leak treated by percutaneous stent implantation and the second, 3 month after transplantation which was treated surgically. Biliary reconstruction after living donor liver transplantation requires microsurgical techniques and can be performed as a direct end-to-end anastomosis in most cases. Biliary complications were treated by percutaneous drainage or surgical revision in all cases.

journal_name

Clin Transplant

journal_title

Clinical transplantation

authors

Settmacher U,Steinmüller TH,Schmidt SC,Heise M,Pascher A,Theruvath T,Hintze R,Neuhaus P

doi

10.1034/j.1399-0012.2003.02058.x

subject

Has Abstract

pub_date

2003-02-01 00:00:00

pages

37-42

issue

1

eissn

0902-0063

issn

1399-0012

pii

2o058

journal_volume

17

pub_type

杂志文章

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