Duct-to-Duct Biliary Reconstructions and Complications in 100 Living Donor Liver Transplantation

Abstract

Background. The biliary complications in duct-to-duct biliary reconstruction of right or left lobe living-donor liver transplantation (LDLT) have been reported various in incidence up to 40 %. And that could result in serious morbidity or mortality to the recipient’s. We evaluated the risk factors for biliary complication and feasible surgical procedure of duct-to-duct reconstruction in adult LDLT. Methods. From February 2005 to March 2008, 100 cases of adult LDLT with duct-to-duct biliary reconstruction were performed. 64 right lobe grafts, 33 left lobe grafts, and 3 right lateral grafts were used. There were four types of duct-to-duct procedure; all interrupted suture with 6-0 prolene (Group 1, n = 9), continuous posterior and interrupted anterior wall suture with 6-0 prolene (Group 2, n = 49), all continuous suture with 7-0 prolene (Group 3, n = 26), and all continuous 7-0 prolene suture with external stent (Group 4, n = 16). Biliary complications were defined as anastomosis stricture and leakage. Results. 34 patients experienced biliary complications during follow-up time (median 27 months). The incidence of stricture was 27% and that of leakage was 8%. There were no risk factors of biliary complication associated with peri-operative, intra-operative, and anatomical characteristics, except types of duct-to-duct procedure. Group 1 and 2 patients had higher incidence of biliary stricture than Group 3 and 4 (43.1% vs. 4.7%, P = 0.00). And Group 3 patients experienced higher incidence of bile leakage than other groups (23.1% vs. 2.7%, P = 0.004). Conclusion. The technical type of biliary reconstruction is the factor affecting biliary complication following duct-to-duct anastomosis in LDLT. Duct-to-duct biliary anastomosis with 7-0 monofilament suture and small external stent is a feasible procedure in LDLT to significantly reduce the incidence of biliary complication.