An analysis of biliary anatomy according to different classification systems

Deka, Pranjal; Islam, Mahibul; Jindal, Deepti; Kumar, Niteen; Arora, Ankur; Negi, Sanjay Singh

doi:10.1007/s12664-013-0371-9

Cited by 31 publications

(27 citation statements)

References 22 publications

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“…Figure contains biliary reconstruction information on 271 recipients, with detailed biliary anatomy for 250 corresponding donors. Biliary anatomy and reconstructive techniques were recorded and classified as previously reported in the literature . Overall, of the 212 RL grafts with known donor biliary anatomy, 86 (41%) contained single right hepatic duct anatomy and most were reconstructed via duct‐to‐duct (1AD; n = 44) or Roux‐en‐Y (1AJ, 2AJAJ, 3AJCJ; n = 35) fashion.…”

Section: Resultsmentioning

confidence: 99%

“…Our primary focus in this study was on the type of biliary reconstruction performed. Reconstruction was categorized into 5 main groups as characterized previously in the literature (32,33) : 1AD, single duct-to-duct; 2CD, ductoplasty to single duct; AJ, all Roux-en-Y anastomoses; ADAJ, a mix of Roux-en-Y and duct-toduct; and AY, reconstruction using high biliary radicals (ie, cystic duct or right/left hepatic duct radicals). Details on the types of hepatic vein, hepatic artery, and portal vein reconstructions were also collected.…”

Section: Intraoperative Data Collectionmentioning

confidence: 99%

“…Biliary anatomy and reconstructive techniques were recorded and classified as previously reported in the literature. (32,33) Overall, of the 212 RL grafts with known donor biliary anatomy, 86 (41%) contained single right hepatic duct anatomy and most were reconstructed via duct-to-duct (1AD; n 5 44) or Rouxen-Y (1AJ, 2AJAJ, 3AJCJ; n 5 35) fashion. For 38 LL grafts with known donor anatomy, 36 (95%) contained single left hepatic duct anatomy.…”

Section: Fig 2 Recipient Biliary Reconstruction By Transplant Centementioning

confidence: 99%

“…Data were recorded chronicling the details of anatomic reconstructive techniques used in the transplant procedures. Although many have described arterial, (4,(13)(14)(15)(16)(17)(18)(19)(20)(21) portal venous, (22)(23)(24)(25) and biliary (26)(27)(28)(29)(30) variants and their potential impact on the living donor procedure, (31)(32)(33)(34)(35)(36)(37)(38)(39) this is the first multiinstitutional investigation with disparate, nonprescribed approaches to biliary reconstructive techniques to study the overall implications of biliary reconstructions and associated anatomic variations on outcomes after LDLT. The aim of this study, in addition to describing the anatomic and surgical variation, was to critically evaluate this unique study cohort to examine the influence of anatomic variations and multiple biliary reconstructive techniques on surgical outcomes and overall graft and patient survival.…”

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confidence: 99%

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Biliary reconstructive techniques and associated anatomic variants in adult living donor liver transplantations: The adult‐to‐adult living donor liver transplantation cohort study experience

Baker

Zimmerman²,

Goodrich

et al. 2017

Liver Transpl

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Introduction Living donor liver transplantation (LDLT) is a technically demanding endeavor, requiring command of the complex anatomy of partial liver grafts. We examined the influence of anatomic variation and reconstruction technique on surgical outcomes and graft survival in the nine-center A2ALL Study. Methods Data from 272 adult LDLT recipients (2011–2015) included details on anatomic characteristics and types of intraoperative biliary reconstruction. Associations were tested between reconstruction technique and complications, which included first biliary complication ([BC]; leak, stricture, or biloma) and first vascular complication (hepatic artery thrombosis [HAT] or portal vein thrombosis [PVT]). Time to patient death, graft failure, and complications were estimated using Kaplan-Meier curves and tested with log-rank tests. Results Median post-transplant follow-up was 1.2 years. Associations were found between the type of biliary reconstruction and the incidence of vascular complication (p=0.034) and BC (p=0.053). Recipients with Roux-en-Y hepatico-jejunostomy had the highest probability of vascular complication. Recipients with biliary reconstruction involving the use of high biliary radicals on the recipient duct had the highest likelihood of developing BC (56% by one year) compared to duct-to-duct (42% by one year). Conclusion The varied surgical approaches in the A2ALL centers offer a novel opportunity to compare disparate LDLT approaches. The choice to use higher biliary radicals on the recipient duct for reconstruction was associated with more BC, possibly secondary to devascularization and ischemia. The use of Roux-en-Y biliary reconstruction was associated with vascular complications (HAT and PVT). These results can be used to guide biliary reconstruction decisions in the setting of anatomic variants and inform further improvements in LDLT reconstructions. Ultimately, this information may contribute to a lower incidence of technical complications after LDLT.

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Section: Resultsmentioning

confidence: 99%

Section: Intraoperative Data Collectionmentioning

confidence: 99%

Section: Fig 2 Recipient Biliary Reconstruction By Transplant Centementioning

confidence: 99%

mentioning

confidence: 99%

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Biliary reconstructive techniques and associated anatomic variants in adult living donor liver transplantations: The adult‐to‐adult living donor liver transplantation cohort study experience

Baker

Zimmerman²,

Goodrich

et al. 2017

Liver Transpl

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“…Furthermore, another type of variation of the biliary tree is the presence of hepaticocholecystic ducts and Luschka ducts, which connect intrahepatic ducts to the gallbaladder or its fossa [6, 7]. In our case, the RPSD joined the RASD to form the RHD, which in turn joined the LHD to form the CHD, as it is common [4, 5], but there was also an aberrant bile duct which connected the RPSD with the cystic duct. What is rare in our case is the coexistence of the common type of the RHD and CHD formation with the aforementioned type of aberrant bile duct, which is added to the long catalogue of the anatomical variations of the biliary tree.…”

Section: Discussionmentioning

confidence: 71%

A rare anatomical variation of the biliary tree

Kostakis

Feretis

Stamopoulos

et al. 2017

Journal of Surgical Case Reports

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A 31-year-old woman was admitted to our department in order to undergo a laparoscopic cholecystectomy. The operation was converted to open due to cholorrhea during the dissection in the hepatocystic triangle. The cholorrhea came from a transected bile duct, which was 2 mm in diameter, came out of the hepatoduodenal ligament, ran along the common hepatic duct and drained into the cystic duct, in proximity to the neck of the gallbladder. The gallbladder was removed and an intraoperative cholangiography revealed that the aberrant bile duct was originated from the right posterior sectoral duct (RPSD). The RPSD continued its typical course up to its confluence with the right anterior sectoral duct and the formation of the right hepatic duct. This is a rare type of aberrant bile duct, which is added to the long catalogue of the anatomical variations of the biliary tree.

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