Identification of a safe and adequate division point of the left-sided bile duct with magnetic resonance cholangiography during donor left lateral sectionectomy

Abstract

Multiple bile duct (BD) openings on the graft can cause postoperative BD-related complications as the result of their small orifices and multiple anastomoses. This study aimed to determine a safe and adequate BD division point during donor left lateral sectionectomy. Left BD was classified into type I: B4 enters the common trunks of B2 and B3; type II: B2 joins the common channels of B3 and B4; or type III: B2, B3, and B4 join. We assessed the chance of multiple openings with 3 BD types in 43 left lateral living donor grafts from January 2004 to January 2011. We also analyzed the potential for multiple openings and right-sided BD injury, based on BD types, during left lateral sectionectomy according to the distance from the crossing point of the right lateral border of the umbilical portion of the left portal vein at the left BD (point U) via preoperative magnetic resonance imaging from another 90 living donors who underwent several types of hepatectomy from January 2012 to December 2012. There was a statistically marginal relevance for multiple openings between BD type I and type II (33.3% in type II vs 7.4% in type I, P = .078), and the optimal BD division points were different by BD types (right-side 5 mm from point U in type I; 10 mm in type II; and 12 mm in type III). The safe and adequate BD division point should be determined according to the left BD types during living donor left lateral sectionectomy.