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Prevention and management of biliary anastomotic stricture in right‐lobe living‐donor liver transplantation
Author(s) -
Chok Kenneth S H,
Lo Chung Mau
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12648
Subject(s) - medicine , anastomosis , liver transplantation , bile duct , cholangiography , roux en y anastomosis , percutaneous transhepatic cholangiography , surgery , biliary tract surgical procedures , surgical anastomosis , percutaneous , living donor liver transplantation , duct (anatomy) , transplantation , biliary tract , radiology , gastric bypass , weight loss , obesity
Abstract Biliary strictures can be categorized according to technical factor as anastomotic or nonanastomotic strictures. Biliary anastomotic stricture is a common complication after living‐donor liver transplantation, occasionally causing deaths. The two most commonly used methods for biliary anastomosis are duct‐to‐duct anastomosis and hepaticojejunostomy. Before presenting a description of the latest techniques of duct‐to‐duct anastomosis and hepaticojejunostomy, this review first relates the technique of donor right hepatectomy, as most biliary complications suffered by recipients of living‐donor liver transplantation originate from donor operations. Three possible causes of biliary anastomotic stricture, namely impaired blood supply, biliary anomaly, and technical flaw, are then discussed. Lastly, the review focuses on the latest management of biliary anastomotic stricture. Treatment modalities include endoscopic retrograde cholangiography with dilatation, percutaneous transhepatic biliary drainage with dilatation, conversion of duct‐to‐duct anastomosis to hepaticojejunostomy, and revision hepaticojejunostomy. End‐to‐side versus side‐to‐side hepaticojejunostomy is also discussed.