Biliary reconstruction following right adult living donor liver transplantation end-to-end or end-to-side duct-to-duct anastomosis

Abstract

The duct-to-duct anastomosis represents a valid alternative to the standard hepaticojejunostomy for right living donor liver grafts. Using this method, biliary complications can be treated endoscopically. End-to-side or end-to-end BARIGA LDLT has the potential to become a standard method in segmental transplantation, including split liver.

Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations

“…10 Right ducts arising separately from the main or left biliary system, a trifurcation, or an early and narrow angled bifurcation make a single anastomotic orifice difficult or even impossible. 5 Intraoperative cholangiography is considered the gold standard to image the biliary tree, but may not be helpful for obtaining a single bile duct orifice in some cases with anatomical variations because it does not allow a three-dimensional view. Thus, we preferred to perform an intraoperative cholangiogram on donors with inadequate magnetic resonance imaging of the biliary tree in the preoperative period.…”

“…In addition to poor vascularization, extensive tension of the anastomosis is another contraindication of D-D reconstruction. 5,6 A double bile duct orifice on the graft is not an absolute contraindication for D-D anastomosis. Two adjacent bile ducts can be converted to a single orifice using plasty sutures.…”

“…4 Surgical technique, quality of the arterial supply of the donor and recipient bile ducts, immunologic factors, and different types of preservation solutions are probable causes of biliary complications. 5 Although cold ischemia times are relatively short, arterial anastomoses are performed using a microsurgical technique, and skeletonization of bile ducts are avoided, biliary complications are still the most frequent surgical morbidity after LDLT. 6 Biliary reconstruction in LDLT using left-lobe allografts is almost always performed over a Roux limb.…”

Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant

“…A transection on an incorrect plane not only increases the number of bile ducts to be anastomosed but increases ischemia risk and the associated risk of anastomosis leak by causing the posteromedial wall of the right posterior bile canal to be skeletonized. 25 The reverse is also true. When there are multiple bile ducts in the right lobe, it becomes technically difficult to determine the transection line accurately, which may lead to oblique or irregular dissection or the injury of the ostia of bile ducts.…”

Living Donor Liver Transplantation

“…The bile duct(s) are reconstructed by using a Roux-en-Y loop or are anastomosed in an end-to-end/end-toside fashion with or without insertion of a T-tube [71,72].…”