Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2649
Peer-review started: December 12, 2020
First decision: December 24, 2020
Revised: December 26, 2020
Accepted: January 27, 2021
Article in press: January 27, 2021
Published online: April 16, 2021
Laparoscopic living donor hepatectomy (LLDH) has been successfully carried out in several transplant centers. Biliary reconstruction is key in living donor liver transplantation (LDLT). Reliable biliary reconstruction can effectively prevent postoperative biliary stricture and leakage. Although preoperative magnetic resonance cholangiopancreatography and intraoperative indocyanine green cholangiography have been shown to be helpful in determining optimal division points, biliary variability and limitations associated with LLDH, multiple biliary tracts are often encountered during surgery, which inhibits biliary reconstruction. A reliable cholangiojejunostomy for multiple biliary ducts has been utilized in LDLT. This procedure provides a reference for multiple biliary reconstructions after LLDH.
A 2-year-old girl diagnosed with ornithine transcarbamylase deficiency required liver transplantation. Due to the scarcity of deceased donors, she was put on the waiting list for LDLT. Her father was a suitable donor; however, after a rigorous evaluation, preoperative magnetic resonance cholangiopancreatography examination of the donor indicated the possibility of multivessel variation in the biliary tract. Therefore, a laparoscopic left lateral section was performed on the donor, which met the estimated graft-to-recipient weight ratio. Under intraoperative indocyanine green cholangiography, 4 biliary tracts were confirmed in the graft. It was difficult to reform the intrahepatic bile ducts due to their openings of more than 5 mm. A reliable cholangiojejunostomy was, therefore, utilized: Suture of the jejunum to the adjacent liver was performed around the bile duct openings with 6/0 absorbable sutures. At the last follow-up (1 year after surgery), the patient was complication-free.
Intrahepatic cholangiojejunostomy is reliable for multiple biliary ducts after LLDH in LDLT.
Core Tip: A patient diagnosed with ornithine transcarbamylase deficiency required liver transplant surgery. After developing a binding surgical plan, we decided to perform a living-donor liver transplantation, using a laparoscopic donor liver resection. However, multiple biliary tracts were observed. We used “Plug-in” anastomosis for cholangio-jejunostomy and received satisfactory results.