Is Microsurgical Technique Useful in Biliary Reconstruction of Living Donor Liver Transplantation?

Abstract Introduction Biliary reconstruction remains the “Achilles' heel” of living donor liver transplantation (LDLT). In the last decades, the technical aspects of biliary reconstruction have been debated for their impact on biliary complications in LDLT. A microsurgical technique in biliary...

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Bibliographic Details
Published in:Transplantation proceedings 2012-03, Vol.44 (2), p.466-468
Main Authors: Kim, J.D, Han, Y.S, Choi, D.L
Format: Article
Language:English
Subjects:
Adult
Anastomosis, Surgical
Bile Duct Diseases - etiology
Bile Ducts - surgery
Biliary Tract Surgical Procedures - adverse effects
Biliary Tract Surgical Procedures - instrumentation
Biological and medical sciences
Feasibility Studies
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Humans
Liver Transplantation - adverse effects
Liver Transplantation - instrumentation
Liver Transplantation - methods
Liver, biliary tract, pancreas, portal circulation, spleen
Living Donors
Male
Medical sciences
Microsurgery - adverse effects
Microsurgery - instrumentation
Middle Aged
Reconstructive Surgical Procedures - adverse effects
Reconstructive Surgical Procedures - instrumentation
Republic of Korea
Stents
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Time Factors
Tissue, organ and graft immunology
Treatment Outcome
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Summary:Abstract Introduction Biliary reconstruction remains the “Achilles' heel” of living donor liver transplantation (LDLT). In the last decades, the technical aspects of biliary reconstruction have been debated for their impact on biliary complications in LDLT. A microsurgical technique in biliary reconstruction is more attractive. Patients and methods From December 2010 to June 2011, 15 primary LDLTs underwent duct-to-duct biliary reconstruction using a microscopic technique. External stents were inserted in all patients. All procedures were performed under a microscope by a single transplant microsurgeon. Results The time consumed for bile duct reconstruction using the microscopic technique was 35 minutes. There were 8 grafts with a single bile duct orifice and seven with two orifices. The average duct size was 3 mm in patients with two orifices and 5 mm in those with a single orifice. There was no bile leak or biliary stricture associated with the biliary reconstruction over a median 5-month follow-up. There were two cases of bile leakage from the cut hepatic surface. Conclusion The microscopic technique reduced early biliary complications. However, further technical advances are needed to decrease the time consumptions for the procedure.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2012.01.058