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Utility of a routine bench cholangiogram for ex situ split liver procedure
Author(s) -
Battula Narendra R.,
Anbarasan Ravindar,
Thumma Venumadhav,
Perera M. Thamara P. R.,
Muiesan Paolo,
Isaac John R.,
Sharif Khalid,
Mirza Darius F.
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13614
Subject(s) - medicine , bch code , liver transplantation , bile duct , biliary drainage , surgery , biliary tract surgical procedures , transplantation , biliary tract , algorithm , decoding methods , computer science
Abstract Background Biliary complications can result in a significant morbidity for split liver graft recipients. Biliary drainage for segment 1 and 4 is highly variable and could be the source of bile leaks. Use of a bench cholangiogram (BCH) can accurately define the segmental biliary system and identify any significant biliary radicles that need retention or repair during bench preparation of split grafts. This study evaluates the clinical relevance of routine BCH in split liver transplantation (SLT). Methods Retrospective review of 100 BCH images performed during ex situ deceased donor SLT between January 2009 and January 2015. The radiographs were reviewed by two surgeons and the biliary anatomy was compared using Huang and Reichert classification. Results 100 BCH images were reviewed. Variant anatomy was frequently identified in the intrahepatic bile duct system, the number and drainage patterns of segment 1&4 duct was diverse. BCH results guided the line of parenchymal transection to obtain a single segment 2&3 duct in 15 cases. A surgical intervention in the form of suture ligation of significant segment 1 or 4 duct at bench preparation was performed in 6 cases. BCH images guided surgical control of post‐operative bile leak in 3 patients. Conclusion Bench cholangiogram is a useful tool to guide liver parenchymal transection and potentially reduce the incidence of biliary complications.