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Choledochoduodenostomy in pediatric liver transplantation. Pediatr Transplant 2011 May;15(3):237-9

Date

01/11/2011

Pubmed ID

21214697

DOI

10.1111/j.1399-3046.2010.01338.x

Scopus ID

2-s2.0-79954479611   5 Citations

Abstract

UNLABELLED: Reconstruction of the bile ducts during pediatric liver transplantation is generally performed by a Roux-en-Y CDJ because direct duct-to-duct anastomosis CC is often not possible. Anastomosis of the donor liver bile duct to the duodenum CDD provides another option. We provide preliminary evidence that CDD is an alternative technique for biliary reconstruction when CC is not possible in pediatric liver transplant recipients that have a hostile abdomen or to preserve bowel length.

METHODS: From 2007 to 2008, a total of 19 pediatric cadaveric liver transplants were performed at our center. Four of the 19 had a bile duct reconstruction by CDD.

RESULTS: CDD reconstruction was used in patients who received a liver transplant for a diagnosis of PSC, congenital hepatic fibrosis, biliary atresia, and Alagille syndrome. The ages of the patients were 17 and 10 yr and 10 and 17 months. Three grafts were whole cadaveric livers, and one was a reduced left lobe. CDD was used to revise a prior anastomosis in one patient who had a previous Roux-en-Y that was unusable during the retransplant, and another to repair a stricture in a second patient with a CC. We also performed a CDD in a patient with a hostile abdomen from previous surgery, and another patient to avoid short gut syndrome that a Roux-en-Y may have created. All patients are alive with functioning grafts with a follow-up of at least one yr. None of the patients developed clinically significant biliary complications (leak, stricture, cholangitis).

CONCLUSION: Our preliminary experience suggests that CDD is an option for biliary reconstruction in pediatric transplant patients with hostile abdomens or to preserve bowel length.

Author List

Campsen J, Zimmerman MA, Narkewicz MR, Sokol RJ, Mandell MS, Kam I, Dovel D, Karrer FM

Author

Michael A. Zimmerman MD, FACS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Anastomosis, Roux-en-Y
Anastomosis, Surgical
Bile Ducts
Biliary Tract Surgical Procedures
Child
Choledochostomy
Female
Humans
Infant
Liver Transplantation
Living Donors
Retrospective Studies
jenkins-FCD Prod-486 e3098984f26de787f5ecab75090d0a28e7f4f7c0