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The technical pitfalls of duct‐to‐duct biliary reconstruction in pediatric living‐donor left‐lobe liver transplantation: The impact of stent placement
Author(s) -
Sakamoto Seisuke,
Egawa Hiroto,
Ogawa Kohei,
Ogura Yasuhiro,
Oike Fumitaka,
Ueda Mikiko,
Yazumi Shujiro,
Shibata Toshiya,
Takada Yasutsugu,
Uemoto Shinji
Publication year - 2008
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2007.00870.x
Subject(s) - medicine , anastomosis , stent , biliary stent , liver transplantation , bile duct , surgery , gauche effect , living donor liver transplantation , left hepatic duct , left lobe , transplantation
The feasibility of D‐D biliary reconstruction in pediatric LDLT using a left‐lobe graft is still controversial. The medical records of 19 pediatric patients (age: four months to 16 yr) were reviewed. The biliary reconstruction was performed in an end‐to‐end fashion using absorbable sutures. An external biliary tube was placed into the bile duct through the anastomotic site (n = 10) and not through the anastomotic site (n = 4). An external tube was not used in five patients. The median follow‐up was 4.7 yr. Nine patients had 11 biliary complications (leakage, n = 2; stricture, n = 7; stricture with leakage, n = 2). Due to biliary complications, conversion to an R‐Y was required in five patients, and four patients required radiological or endoscopic management. The patients younger than one yr of age required conversion to R‐Y within one wk after LDLT. The analysis of factors related to biliary complications revealed that the use of a trans‐anastomotic biliary tube was the only significant factor to avoid biliary complications. In conclusion, D‐D biliary reconstruction in LDLT using a left‐lobe graft is feasible in selected cases, though it remains challenging. The use of a trans‐anastomotic biliary tube is important to avoid biliary complications.