A New Approach to Overcoming Biliary Complications after Laparoscopic Living Donor Liver Transplantation

Aims: Biliary strictures and bile leaks are one of the major causes of morbidity after liver transplantation. Biliary reconstruction of multiple ducts in grafts is challenging in living donor liver transplantation (LDLT). We introduce our new approach of dunking duct reconstruction of the bile duct for reducing bile duct complications in LDLT. Methods: Twenty consecutive LDLT with laparoscopic living donor graft from February to September 2017 were analyzed through a comparison of 10 conventional duct-to-duct reconstructions (DDR) and 10 dunking hepaticocholedocostomy (DHC) in bile duct anastomoses. Results: At a mean follow-up of 5.4 months, median graft duct number for DDR is one and for DHC is two. Overall, 3 patients developed leakage (15%) and 4 patients suffered stricture (20%). For biliary anastomosis with DDR, the incidence of stricture and leakage was significantly higher (40%, 20%) than DHC (0%, 10%). Conclusions: In conclusion, DHC in graft with multiple ducts as well as in graft with single bile ducts has excellent results with regard to minimizing biliary complications. Therefore, DHC can be recommended as the preferred method for the presence of multiple ducts in the graft in LDLT.