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Hepaticoduodenostomy is an alternative to Roux-en-Y hepaticojejunostomy for biliary reconstruction in live donor liver transplantation. Transplantation 2009 Jun 27;87(12):1842-5

Date

06/23/2009

Pubmed ID

19543062

DOI

10.1097/TP.0b013e3181a6bb5e

Scopus ID

2-s2.0-67649631454   8 Citations

Abstract

INTRODUCTION: A Roux-en-Y hepaticojejunostomy (HJ) is usually performed during live donor liver transplantation (LDLT) when a duct-to-duct reconstruction is not possible. However, direct anastomosis of the bile duct to the duodenum (hepaticoduodenostomy [HD]) is an alternative technique for biliary repair that has been previously used for conventional biliary surgery and at our center for cadaveric liver transplant. We provide the first evidence that HD is an alternative technique for biliary reconstruction in LDLT.

METHODS: We performed a total of 71 LDLT between 2002 and 2008. An end-to-end anastomosis was used in 30 patients. Forty-one patients had a biliary enteric anastomosis in which seven were reconstructed with an HD. Accessory ducts were fashioned into a common duct or implanted into the duodenum separately.

RESULTS: There were no patient deaths or retransplants in a follow-up period that ranged from 90 to 771 days after surgery. One patient was diagnosed with cholangitis that responded to intravenous antibiotics and removal of the stent by endoscopy.

CONCLUSIONS: This preliminary case series suggests that that HD is a feasible alternative to HJ biliary anastomosis when a duct-to-duct anastomosis cannot be performed. HD offers the possible advantage of simple postoperative access to the biliary system by endoscopy and avoids complications caused by HJ bowel anastomosis.

Author List

Campsen J, Zimmerman MA, Mandell MS, Wachs M, Bak T, Forman L, Steinberg T, Kam I

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

Adult
Aged
Anastomosis, Roux-en-Y
Anastomosis, Surgical
Cholangiography
Duodenostomy
Female
Gallbladder
Hepatectomy
Humans
Length of Stay
Liver Transplantation
Living Donors
Male
Middle Aged
Monitoring, Intraoperative
Reconstructive Surgical Procedures
Retrospective Studies
jenkins-FCD Prod-486 e3098984f26de787f5ecab75090d0a28e7f4f7c0