It was reported via journal article: "title: long-term analysis of biliary complications after duct-to-duct biliary reconstruction in living donor liver transplantations authors: sung yeon hong, xu-guang hu, hyun young lee, je hwan won, jin woo kim, xue-yin shen, hee-jung wang, bong-wan kim.Citation: liver transpl.2018.Doi: 10.1002/lt.25074.The study aims to evaluate the long-term outcomes of duct-to duct (dd) biliary reconstruction using 7-0 suture and to identify the risk factors of biliary complications (bcs) after living donor liver transplantation (ldlt).Between november 2006 and december 2015, a total of 140 ldlt recipients (104 male and 36 female patients; age range: 23 to 70 years old) underwent dd biliary reconstruction in a tertiary hospital and were included in the study.Among the 140 ldlts, 102 were performed with right lobe grafts, 20 at the left lobe, and 18 at the right posterior sector.During the duct-to-duct anastomosis, both 3 and 9 o¿clock corners of the graft¿s and recipient¿s bile duct opening were suture-anchored by double-arm needle prolene 7-0.Then, the 3 o¿clock corner suture was tied and the posterior wall of the bile ducts was sutured continuously from a 3 to a 9 o¿clock direction.The suture was performed in the manner of a duct-to-mucosa anastomosis, which was conducted as transductal stitches on the graft¿s duct and transmucosal stitches on the everted recipient¿s duct.(12, 14) after completion of the posterior wall suture, the bile ducts¿ anterior walls were sutured in the same manner as the posterior wall anastomosis using the other needle, from the 3 to 9 o¿clock direction.The distance between each stitch was about 0.5 to 0.7 mm.Reported complications included case 1, a (b)(6) male patient with bile leakage (bl) which required endoscopic retrograde biliary drainage (erbd), case 2, a (b)(6) male patient with bl and biliary stricture (bs) which required endoscopic naso-biliary drainage (enbd) and percutaneous transhepatic biliary drainage (ptbd), case 3, a (b)(6) male patient with bl and bs which required percutaneous drainage (pcd) and ptbd, case 4, a (b)(6) male patient with bl and bs which required pcd and ptbd, case 5, a (b)(6)male patient with bl which required erbd, case 6, a (b)(6) female patient with bs which required ptbd, case 7, a (b)(6) male patient with bs which required ptbd, case 8, a (b)(6) female patient with bs which required ptbd, case 9, a (b)(6) female patient with bs which required ptbd, case 10, a (b)(6) male patient with bs which required ptbd, case 11, a (b)(6) male patient with bl which required endoscopic sphincterectomy (est), case 12, a (b)(6) female patient with bl and bs which required erbd and ptbd, case 13, a (b)(6) male patient with bl and bs which required enbd and ptbd, case 14, a (b)(6) male patient with bs which required ptbd, case 15, a (b)(6) male patient with bs which required ptbd, case 16, a (b)(6) male patient with bs which required ptbd, case 17, a (b)(6) male patient with bs which required ptbd, case 18, a (b)(6) male patient with bs which required ptbd, case 19, a (b)(6) male patient with bs which required ptbd.It was concluded that dd anastomosis using 7-0 suture combined with ebs could provide favorable long-term outcomes after ldlt, which should thus be considered the surgical technique of choice for ldlts.
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