Biliary complications in adult living donor liver transplantation with duct-to-duct hepaticocholedochostomy or Roux-en-Y hepaticojejunostomy biliary reconstruction

Shigeyuki Kawachi, Motohide Shimazu, Go Wakabayashi, Ken Hoshino, Minoru Tanabe, Masashi Yoshida, Yasuhide Morikawa, Masaki Kitajima

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Abstract

Background. The aim of this study was to compare lhe incidence of biliary complications after adult living donor liver transplantation (ALDLT) with Roux-en-Y hepaticojejunostomy (R-Y HJ) or duct-to-duct hepaticocholedochostomy (D-D HC). Methods. Biliary complications were reviewed in 20 consecutive ALDLT recipients surviving more than 1 month, including 10 patients who underwent R-Y HJ and 10 patients who underwent D-D HC reconstructions. Results. Ten biliary complications were seen in 8 patients (40%) from the study group. Specifically, 1 case of biliary leakage and 1 case of biliary hemorrhage were observed in the R-Y HJ group (20%), and 2 biliary leakages, 4 biliary strictures, and 2 C-tube related biliary leakages were seen in 6 patients from the D-D HC group (60%). Three of the 5 patients (60%) who underwent right lobe graft ALDLTs experienced biliary stricture. All cases of biliary leakage and biliary hemorrhage were stopped spontaneously by continuous drainage. Three patients in the D-D HC group with anastomotic strictures were successfully treated with percutaneous interventions. Only 1 patient with anastomotic stricture in the D-D HC group with left lobe graft required intrahepatie R-Y HJ reanastomosis. Two cases of C-tube related biliary leakages were treated with endoscopic management. Conclusions. Biliary complications such as anastomotic strictures were common in the D-D HC group rather than in the R-Y HJ group. D-D HC reconstruction should be applied cautiously, especially in the right lobe graft ALDLT cases.

Original languageEnglish
Pages (from-to)48-56
Number of pages9
JournalSurgery
Volume132
Issue number1
DOIs
Publication statusPublished - 2002

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Living Donors
Liver Transplantation
Pathologic Constriction
Transplants
Hemorrhage
Drainage
Incidence

ASJC Scopus subject areas

  • Surgery

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Biliary complications in adult living donor liver transplantation with duct-to-duct hepaticocholedochostomy or Roux-en-Y hepaticojejunostomy biliary reconstruction. / Kawachi, Shigeyuki; Shimazu, Motohide; Wakabayashi, Go; Hoshino, Ken; Tanabe, Minoru; Yoshida, Masashi; Morikawa, Yasuhide; Kitajima, Masaki.

In: Surgery, Vol. 132, No. 1, 2002, p. 48-56.

Research output: Contribution to journalArticle

Kawachi, S, Shimazu, M, Wakabayashi, G, Hoshino, K, Tanabe, M, Yoshida, M, Morikawa, Y & Kitajima, M 2002, 'Biliary complications in adult living donor liver transplantation with duct-to-duct hepaticocholedochostomy or Roux-en-Y hepaticojejunostomy biliary reconstruction', Surgery, vol. 132, no. 1, pp. 48-56. https://doi.org/10.1067/msy.2002.125314
Kawachi, Shigeyuki ; Shimazu, Motohide ; Wakabayashi, Go ; Hoshino, Ken ; Tanabe, Minoru ; Yoshida, Masashi ; Morikawa, Yasuhide ; Kitajima, Masaki. / Biliary complications in adult living donor liver transplantation with duct-to-duct hepaticocholedochostomy or Roux-en-Y hepaticojejunostomy biliary reconstruction. In: Surgery. 2002 ; Vol. 132, No. 1. pp. 48-56.
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abstract = "Background. The aim of this study was to compare lhe incidence of biliary complications after adult living donor liver transplantation (ALDLT) with Roux-en-Y hepaticojejunostomy (R-Y HJ) or duct-to-duct hepaticocholedochostomy (D-D HC). Methods. Biliary complications were reviewed in 20 consecutive ALDLT recipients surviving more than 1 month, including 10 patients who underwent R-Y HJ and 10 patients who underwent D-D HC reconstructions. Results. Ten biliary complications were seen in 8 patients (40{\%}) from the study group. Specifically, 1 case of biliary leakage and 1 case of biliary hemorrhage were observed in the R-Y HJ group (20{\%}), and 2 biliary leakages, 4 biliary strictures, and 2 C-tube related biliary leakages were seen in 6 patients from the D-D HC group (60{\%}). Three of the 5 patients (60{\%}) who underwent right lobe graft ALDLTs experienced biliary stricture. All cases of biliary leakage and biliary hemorrhage were stopped spontaneously by continuous drainage. Three patients in the D-D HC group with anastomotic strictures were successfully treated with percutaneous interventions. Only 1 patient with anastomotic stricture in the D-D HC group with left lobe graft required intrahepatie R-Y HJ reanastomosis. Two cases of C-tube related biliary leakages were treated with endoscopic management. Conclusions. Biliary complications such as anastomotic strictures were common in the D-D HC group rather than in the R-Y HJ group. D-D HC reconstruction should be applied cautiously, especially in the right lobe graft ALDLT cases.",
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AU - Kawachi, Shigeyuki

AU - Shimazu, Motohide

AU - Wakabayashi, Go

AU - Hoshino, Ken

AU - Tanabe, Minoru

AU - Yoshida, Masashi

AU - Morikawa, Yasuhide

AU - Kitajima, Masaki

PY - 2002

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N2 - Background. The aim of this study was to compare lhe incidence of biliary complications after adult living donor liver transplantation (ALDLT) with Roux-en-Y hepaticojejunostomy (R-Y HJ) or duct-to-duct hepaticocholedochostomy (D-D HC). Methods. Biliary complications were reviewed in 20 consecutive ALDLT recipients surviving more than 1 month, including 10 patients who underwent R-Y HJ and 10 patients who underwent D-D HC reconstructions. Results. Ten biliary complications were seen in 8 patients (40%) from the study group. Specifically, 1 case of biliary leakage and 1 case of biliary hemorrhage were observed in the R-Y HJ group (20%), and 2 biliary leakages, 4 biliary strictures, and 2 C-tube related biliary leakages were seen in 6 patients from the D-D HC group (60%). Three of the 5 patients (60%) who underwent right lobe graft ALDLTs experienced biliary stricture. All cases of biliary leakage and biliary hemorrhage were stopped spontaneously by continuous drainage. Three patients in the D-D HC group with anastomotic strictures were successfully treated with percutaneous interventions. Only 1 patient with anastomotic stricture in the D-D HC group with left lobe graft required intrahepatie R-Y HJ reanastomosis. Two cases of C-tube related biliary leakages were treated with endoscopic management. Conclusions. Biliary complications such as anastomotic strictures were common in the D-D HC group rather than in the R-Y HJ group. D-D HC reconstruction should be applied cautiously, especially in the right lobe graft ALDLT cases.

AB - Background. The aim of this study was to compare lhe incidence of biliary complications after adult living donor liver transplantation (ALDLT) with Roux-en-Y hepaticojejunostomy (R-Y HJ) or duct-to-duct hepaticocholedochostomy (D-D HC). Methods. Biliary complications were reviewed in 20 consecutive ALDLT recipients surviving more than 1 month, including 10 patients who underwent R-Y HJ and 10 patients who underwent D-D HC reconstructions. Results. Ten biliary complications were seen in 8 patients (40%) from the study group. Specifically, 1 case of biliary leakage and 1 case of biliary hemorrhage were observed in the R-Y HJ group (20%), and 2 biliary leakages, 4 biliary strictures, and 2 C-tube related biliary leakages were seen in 6 patients from the D-D HC group (60%). Three of the 5 patients (60%) who underwent right lobe graft ALDLTs experienced biliary stricture. All cases of biliary leakage and biliary hemorrhage were stopped spontaneously by continuous drainage. Three patients in the D-D HC group with anastomotic strictures were successfully treated with percutaneous interventions. Only 1 patient with anastomotic stricture in the D-D HC group with left lobe graft required intrahepatie R-Y HJ reanastomosis. Two cases of C-tube related biliary leakages were treated with endoscopic management. Conclusions. Biliary complications such as anastomotic strictures were common in the D-D HC group rather than in the R-Y HJ group. D-D HC reconstruction should be applied cautiously, especially in the right lobe graft ALDLT cases.

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