Outcome of routine use of microsurgical biliary reconstruction in pediatric living donor liver transplantation

• Published in: Journal of hepato-biliary-pancreatic sciences 2013-06, Vol.20 (5), p.492-497
• Main Authors: Chen, Chao-Long, Concejero, Allan M., Lin, Tsan-Shiun, Lin, Yu-Hung, Chiang, Yuan-Cheng, Wang, Chih-Chi, Wang, Shih-Ho, Lin, Chih-Che, Liu, Yueh-Wei, Yong, Chee-Chien
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adolescent; biliary complications; biliary reconstruction; Child; Child, Preschool; Female; Follow-Up Studies; Gastroenterology; Hepatology; Humans; Infant; Liver cirrhosis; Liver Transplantation; Living Donors; Male; Medicine; Medicine & Public Health; Microsurgery - methods; microsurgical technique; pediatric living donor liver transplant; pediatrics; Postoperative Complications; Reconstructive Surgical Procedures - methods; Surgical Oncology; Taiwan; Topics; Transplants & implants; Treatment Outcome
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1007/s00534-013-0609-z

Objective Microsurgical techniques, initially used for hepatic artery reconstruction, have been extended to biliary reconstruction to decrease biliary complications. The routine use of microsurgical biliary reconstruction in pediatric living donor liver transplantation (LDLT) has not been elucidated. Methods Sixty-seven pediatric patients underwent primary LDLT. All biliary reconstructions were performed by a single microsurgeon using microsurgical techniques. A biliary stent was not used. The minimum follow-up was 12 months. Thirty-four patients had a minimum follow-up of 36 months. The outcomes of those who underwent microsurgical biliary reconstruction were compared with the outcomes of a cohort of 67 patients who underwent conventional biliary reconstruction. Results The demographical and clinical profiles of the two groups were not significantly different. There were 5 anastomotic complications in the conventional and 2 anastomotic complications in the microsurgical reconstruction groups. All complications developed within 90 days after transplant. There were no late biliary complications. Further analysis showed that conventional reconstruction increased the risk of biliary complications by 2.4 times (relative risk: 2.42; attributable risk: 4.5). Conclusion The routine use of microsurgical biliary reconstruction in pediatric LDLT is a technical innovation that led to decreased anastomotic biliary complications.