Choledocho-choledochostomy in deceased donor liver transplantation

Biliary complications following deceased donor liver transplantation occur with an incidence of approximately 5-10%. The most common type of biliary reconstruction in whole-organ deceased donor liver transplantation remains the choledocho-choledochostomy, which creates an anastomosis between the donor and recipient common bile ducts or common hepatic ducts. Key elements in performing a successful choledocho-choledochostomy include ensuring that bile ducts have adequate blood supply and avoiding mechanical trauma or tension on the anastomosis. Techniques including ductoplasty and spatulation can be used to fashion an anastomosis even in the face of significant size mismatch between donor and recipient bile ducts. This article describes the technique of choledocho-choledochostomy in deceased donor liver transplantation.