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Bilioenteric Reconstruction Techniques in Pediatric Living Donor Liver Transplantation
Murat Kilic1, Can A Karaca, Cahit Yilmaz
1Department of Liver Transplantation Izmir Kent Hospital Izmir Turkey Faculty of Medicine Izmir University of Economics Izmir Turkey Department of Pediatric Gastroenterology Ege University Faculty of Medicine Izmir Turkey.
Insights
Duct-to-duct anastomosis is a safe and feasible biliary reconstruction technique in pediatric living donor liver transplantation, showing comparable outcomes to Roux-en-Y hepaticojejunostomy for reducing complications.
Area of Science:
- Hepatobiliary Surgery
- Pediatric Transplantation
- Surgical Reconstruction
Background:
- Biliary complications remain a significant cause of morbidity after liver transplantation.
- Roux-en-Y hepaticojejunostomy is the standard pediatric biliary reconstruction, but duct-to-duct anastomosis feasibility is debated.
Purpose of the Study:
- To evaluate the feasibility and outcomes of duct-to-duct biliary reconstruction in pediatric living donor liver transplantation.
- To compare the incidence of biliary complications between duct-to-duct and Roux-en-Y techniques.
Main Methods:
- Retrospective analysis of 154 pediatric living donor liver transplantations.
- Patients grouped by biliary reconstruction technique: duct-to-duct vs. Roux-en-Y.
- Comparison of biliary complication rates, including strictures and bile leaks.
Main Results:
- Overall biliary complication rate was 13% with no significant difference between the two groups (P=0.6).
- Strictures and bile leaks occurred at similar rates in both duct-to-duct and Roux-en-Y groups.
- Duct-to-duct reconstruction demonstrated comparable safety and efficacy to Roux-en-Y.
Conclusions:
- Duct-to-duct biliary reconstruction is a safe and feasible option in pediatric living donor liver transplantation.
- This technique achieves outcomes comparable to Roux-en-Y hepaticojejunostomy.
- DD reconstruction offers a more physiological approach to bilioenteric integrity.
Abstract:
Biliary complications (BCs) are still a major cause of morbidity following liver transplantation despite the advancements in the surgical technique. Although Roux-en-Y (RY) hepaticojejunostomy has been the standard technique for years in pediatric patients, there is a limited number of reports on the feasibility of duct-to-duct (DD) anastomosis, and those reports have controversial outcomes. With the largest number of patients ever reported on the topic, this study aims to discuss the feasibility of the DD biliary reconstruction technique in pediatric living donor liver transplantation (LDLT). After the exclusion of the patients with biliary atresia, patients who received either deceased donor or right lobe grafts, and retransplantation patients, data from 154 pediatric LDLTs were retrospectively analyzed. Patients were grouped according to the applied biliary reconstruction technique, and the groups were compared using BCs as the outcome. The overall BC rate was 13% (n = 20), and the groups showed no significant difference (P = 0.6). Stricture was more frequent in the DD reconstruction group; however, this was not statistically significant (P = 0.6). The rate of bile leak was also similar in both groups (P = 0.6). The results show that the DD reconstruction technique can achieve similar outcomes when compared with RY anastomosis. Because DD reconstruction is a more physiological way of establishing bilioenteric integrity, it can safely be applied.
