Minimal Hilar Dissection Prevents Biliary Anastomotic Stricture After Living Donor Liver Transplantation

Abstract

We introduced a new technique called minimal hilar dissection (Min-HD) technique in living donor liver transplantation (LDLT) to keep vascular networks around the recipient's bile duct. The aim of this study is to investigate whether the Min-HD technique could prevent biliary anastomotic stricture (BAS) after LDLT with duct-to-duct biliary reconstruction. An analysis of 214 adult-to-adult LDLT grafts (left lobe, n=135; right lobe, n=76; posterior segment, n=3) with duct-to-duct biliary reconstruction was performed. There were 46 cases with BAS. The incidence of BAS was 32.1% in the conventional technique group (n=84) and 14.6% in the Min-HD technique group (n=130, P=0.003). Multivariate regression analysis regarding BAS was carried out and detected hepatic artery flow less than 50 mL/min (P=0.002), not using the Min-HD technique (P=0.011), biliary anastomotic leakage (BAL, P=0.027) and ductoplasty (P=0.039) for the significant risk factors for BAS. The incidence BAL was 11.9% in the conventional technique group and 0.7% in the Min-HD technique group (P=0.002). No other factors showed an impact on the occurrence of BAL. The treatments for BAS were performed by endoscopic or percutaneous procedures. The cumulative completion rate of the treatment after developing BAS was 45.1% and 78.6% at 1- and 3-year, respectively. The median period for treating BAS was 10.8 months. The Min-HD technique is a rational surgical method, and it has the potential for preventing BAS and BAL after duct-to duct biliary reconstruction in LDLT.