Korean J Transplant.  2023 Nov;37(Suppl 1):S253. 10.4285/ATW2023.F-8441.

Surgical tips of duct-to-duct bile duct anastomosis in unusual situations in living donor liver transplantation

• Choi HH
• Lee KW

• KMID: 2551882
• DOI: http://doi.org/10.4285/ATW2023.F-8441

Abstract

Background
In living donor liver transplantation using the right graft, the bile duct is typically connected in an end-to-end duct-to-duct anastomosis between the grafts right bile duct (gRBD) and the recipients common hepatic duct (rCHD). However, in some cases, the recipients cystic duct (rCD) is inevitably used for the anastomosis due to angulation problem or size discrepancy. Additionally, two separate bile duct openings with far distance in the graft also difficult to perform duct-to-duct anastomosis. In this video, we aim to introduce a surgical technique that overcomes these challenges.
Methods
In the first case, there was an acute angle problem expected when rCHD is used for duct-to-duct anastomosis. Therefore, the gRBD was anastomosed with rCD and the rCHD was ligated. In the second case, the gRBD was exposed in two parts. The right anterior bile duct was connected to the recipients left bile duct opening using an interrupted technique, while the right posterior bile duct was connected to the recipients right bile duct opening in a mixed manner (continuous posterior wall and interrupted anterior wall). This was done without stent insertion and secured with 6-0 Maxon sutures.
Results
With this surgical technique, we were able to safely anastomose the gRBD with the relatively smaller rCD without any angulation or leakage.
Conclusions
When duct-to-duct anastomosis is challenging due to acute angle or size discrepancy, various modified techniques can be favorable alternatives to overcome these issues.