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Surgical Technique of Biliary Reconstruction in Adult-to-Adult Living Donor Liver Transplantation: Survey of 9 Major Centers in Korea  

Yi, Nam-Joon (Deparment of Surgery Seoul National University College of Medicine)
Kwon, Choon-Hyuck David (Deparment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Kim, Keon-Kuk (Deparment of Surgery, Gachon Medical School, Gil Medical Center)
Kim, Bong-Wan (Deparment of Surgery, Ajou University Hospital, Ajou University School of Medicine)
You, Young-Kyoung (Deparment of Surgery, The Catholic University of Korea, College of Medicine)
Choi, Jin-Sub (Deparment of Surgery, Yonsei University College of Medicine)
Ha, Tae-Yong (Deparment of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Han, Young-Seok (Deparment of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Lee, Kwang-Woong (Deparment of Surgery, Seoul National University College of Medicine)
Publication Information
Annals of Hepato-Biliary-Pancreatic Surgery / v.14, no.4, 2010 , pp. 219-226 More about this Journal
Abstract
Purpose: Despite refinements in the surgical techniques for adult-to-adult living donor liver transplantation (ALDLT), biliary complications still remain the Achilles' heel of ALDLT. Moreover, there is no consensus for the ideal technique of biliary reconstruction to reduce the rate of complications to an acceptable range. We strove to collate the available data of the current surgical techniques for biliary reconstruction in ALDLT in Korea. Methods: A questionnaire concerning the surgical techniques for biliary reconstruction was sent to 9 surgeons who performed biliary anastomosis in the major LDLT centers of Korea (the response rate was 100%). Results: MR cholangiography (n=7) and/or intra-operative cholangiography (n=5) were routinely performed to evaluate the donor biliary anatomy. All the participants (n=9) preferred duct-to-duct anastomosis to hepatico-jejunostomy. Anastomosis was usually made on the whole layer (n=7 epithelium, n=2) of recipient's common hepatic duct under loupe magnification (n=8); only one center reconstructed the anastomosis on the $2^{nd}$ order hepatic duct under view of a surgical microscope. There were various techniques for biliary reconstruction as follows: suture material (absorbable: n=5, non-absorbable: n=4), suture method (continuous: n=4, interrupted: n=3, mixed: n=3) and the use of a biliary stent (routine: n=3, sometimes: n=5, rare: n=1). Ductoplasty was performed on the back table (n=7) for the cases with a very close distance (<5 mm) between the bile ducts' openings, but each duct was separately anastomosed to the recipients' bile duct (n=8) or a roux-en-Y limb (n=1) was done in cases with a distance more than 10 mm. Conclusion: In 9 LDLT centers of Koreas, duct-to-duct was preferred; however, there was no unique consensus, among the major centers, for the biliary reconstruction techniques that might reduce complications.
Keywords
Biliary; Complications; Living donor liver Transplantation; Survey; Korea;
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