Biliary reconstruction in pediatric live donor liver transplantation

Duct-to-duct or Roux-en-Y hepaticojejunostomy

Hideaki Tanaka, Akinari Fukuda, Takanobu Shigeta, Tatsuo Kuroda, Takuya Kimura, Seisuke Sakamoto, Mureo Kasahara

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Duct-to-duct biliary reconstruction (DD) is currently a standard procedure in adult live donor liver transplantation (LDLT). Its pediatric feasibility, however, has rarely been reported. The goal of this study is to assess the incidence and treatment of biliary complication after pediatric LDLT with DD or Roux-en-Y hepaticojejunostomy (RY). Method: Sixty children received LDLT between November 2005 and June 2008, and their database was reviewed. Results: Biliary reconstruction was achieved with DD in 14 patients and with RY in 46 patients with mean follow-up period of 26.0 and 22.3 months, respectively. The incidence of biliary leakage in the DD and RY groups was 7.1% and 8.7%, respectively, and that of stricture was 28.6% and 10.9%, respectively; but the differences were not statistically significant. Biliary stricture in the DD group tended to require revision surgery with RY and longer treatment with percutaneous transhepatic cholangiodrainage compared with that in the RY group. Conclusion: Theoretical advantages of DD over RY were not confirmed in this study. Duct-to-duct biliary reconstruction tended to encounter more biliary complications, especially stricture, with more difficulty in treating it than RY. Roux-en-Y hepaticojejunostomy seems preferable to DD in the setting of pediatric LDLT, but DD must be considered when making new Roux-en-Y limb seems impossible or troublesome owing to abdominal dense adhesion or short bowel syndrome.

Original languageEnglish
Pages (from-to)1668-1675
Number of pages8
JournalJournal of Pediatric Surgery
Volume45
Issue number8
DOIs
Publication statusPublished - 2010 Aug
Externally publishedYes

Fingerprint

Liver Transplantation
Tissue Donors
Pediatrics
Pathologic Constriction
Short Bowel Syndrome
Incidence
Reoperation
Extremities
Databases
Therapeutics

Keywords

  • Complication
  • Duct-to-duct biliary reconstruction
  • Live donor liver transplantation
  • Pediatric

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Biliary reconstruction in pediatric live donor liver transplantation : Duct-to-duct or Roux-en-Y hepaticojejunostomy. / Tanaka, Hideaki; Fukuda, Akinari; Shigeta, Takanobu; Kuroda, Tatsuo; Kimura, Takuya; Sakamoto, Seisuke; Kasahara, Mureo.

In: Journal of Pediatric Surgery, Vol. 45, No. 8, 08.2010, p. 1668-1675.

Research output: Contribution to journalArticle

Tanaka, Hideaki ; Fukuda, Akinari ; Shigeta, Takanobu ; Kuroda, Tatsuo ; Kimura, Takuya ; Sakamoto, Seisuke ; Kasahara, Mureo. / Biliary reconstruction in pediatric live donor liver transplantation : Duct-to-duct or Roux-en-Y hepaticojejunostomy. In: Journal of Pediatric Surgery. 2010 ; Vol. 45, No. 8. pp. 1668-1675.
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abstract = "Background: Duct-to-duct biliary reconstruction (DD) is currently a standard procedure in adult live donor liver transplantation (LDLT). Its pediatric feasibility, however, has rarely been reported. The goal of this study is to assess the incidence and treatment of biliary complication after pediatric LDLT with DD or Roux-en-Y hepaticojejunostomy (RY). Method: Sixty children received LDLT between November 2005 and June 2008, and their database was reviewed. Results: Biliary reconstruction was achieved with DD in 14 patients and with RY in 46 patients with mean follow-up period of 26.0 and 22.3 months, respectively. The incidence of biliary leakage in the DD and RY groups was 7.1{\%} and 8.7{\%}, respectively, and that of stricture was 28.6{\%} and 10.9{\%}, respectively; but the differences were not statistically significant. Biliary stricture in the DD group tended to require revision surgery with RY and longer treatment with percutaneous transhepatic cholangiodrainage compared with that in the RY group. Conclusion: Theoretical advantages of DD over RY were not confirmed in this study. Duct-to-duct biliary reconstruction tended to encounter more biliary complications, especially stricture, with more difficulty in treating it than RY. Roux-en-Y hepaticojejunostomy seems preferable to DD in the setting of pediatric LDLT, but DD must be considered when making new Roux-en-Y limb seems impossible or troublesome owing to abdominal dense adhesion or short bowel syndrome.",
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