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Duct‐to‐duct biliary reconstruction in selected cases in pediatric living‐donor left‐lobe liver transplantation
Author(s) -
Liu Chinsu,
Loong CheChuan,
Hsia ChengYuan,
Peng ChengKang,
Tsai HsinLin,
Tsou MeiYung,
Wei Choufu
Publication year - 2009
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.1399-3046.2008.01040.x
Subject(s) - medicine , hepatoduodenal ligament , anastomosis , stent , surgery , living donor liver transplantation , biliary stent , liver transplantation , left lobe , bile duct , lobe , gauche effect , transplantation , radiology , resection , anatomy
The feasibility of D‐D biliary reconstruction in pediatric LDLT using left‐lobe graft has been discussed in few reports. The use of a trans‐anastomotic biliary tube seemed to be the favorable method to avoid the complications according to these reports. We had performed left‐lobe LDLT for seven pediatric cases and D‐D was done originally. Three cases were converted to R‐Y hepaticojejunostomy due to radical resection of hepatoduodenal ligament (n = 1) and severe kinking of D‐D (n = 2). Four cases received D‐D using 6‐0 PDS interrupted sutures without external stent tube. One D‐D case died of intra‐cerebral hemorrhage 10 days after operation with a functioning graft. There was one biliary leakage in a D‐D patient who required PTCD stent for 4 months without any sequale. From our limited experience, D‐D biliary reconstruction without external stent tube in left‐lobe LDLT is feasible in certain pediatric cases having normal extra‐hepatic bile ducts. In smaller recipient with larger graft, the use of a trans‐anastomotic biliary tube can prevent anastomotic kinking although we suggest R‐Y biliary reconstruction is better for this condition.