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01.12.2023 | Original Article

The advantages of duct-to-duct biliary reconstruction in pediatric living donor liver transplantation

verfasst von: Yukihiro Toriigahara, Toshiharu Matsuura, Yusuke Yanagi, Koichiro Yoshimaru, Yasuyuki Uchida, Keisuke Kajihara, Takeshi Shirai, Yuki Kawano, Naonori Kawakubo, Kouji Nagata, Tatsuro Tajiri

Erschienen in: Pediatric Surgery International | Ausgabe 1/2023

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Abstract

Background/Purpose

Whether Roux-en-Y hepatic jejunectomy (HJ) or duct-to-duct biliary reconstruction (DD) is more useful in pediatric living donor liver transplantation has not yet been fully investigated. Therefore, to assess the feasibility and safety of DD, we compared the surgical outcomes of DD to HJ.

Methods

We divided 45 patients, excluding those with biliary atresia, into the DD group (n = 20) and the HJ group (n = 25), according to the type of biliary reconstruction they received.

Results

The 5-year survival rates (DD vs. HJ = 79.7% vs. 83.6%, p = 0.70) and the incidence of biliary complications, including bile leakage and stricture (DD vs. HJ = 1 [5.0%] vs. 1 [4.0%], p = 0.87) were not significantly different between the groups. However, intestinal complications, including bowel perforation or ileus, were significantly common in the HJ group (9/25 [36.0%]) than in the DD group (1/20 [5.0%]; p = 0.01). The three patients in the HJ group with intestinal perforation all suffered perforation at the anastomosed site in the Roux-en-Y procedure. The subgroup analysis showed the non-inferiority of DD to HJ for biliary or intestinal complications in patients weighting < 10 kg.

Conclusion

With a proper selection of cases, DD should be a safe method for biliary reconstruction in pediatric recipients with little risk of biliary complications equivalent to HJ and a reduced risk of intestinal complications.

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Titel: The advantages of duct-to-duct biliary reconstruction in pediatric living donor liver transplantation
verfasst von: Yukihiro Toriigahara
Toshiharu Matsuura
Yusuke Yanagi
Koichiro Yoshimaru
Yasuyuki Uchida
Keisuke Kajihara
Takeshi Shirai
Yuki Kawano
Naonori Kawakubo
Kouji Nagata
Tatsuro Tajiri
Publikationsdatum: 01.12.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 1/2023
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-023-05568-x

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The advantages of duct-to-duct biliary reconstruction in pediatric living donor liver transplantation