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Li H, Wei L, Zhu M, Zeng Z, Qu W, Zhu Z. A novel approach of intraoperative cholangiography in laparoscopic left lateral sectionectomy in living donor liver transplantation. Surg Endosc 2023:10.1007/s00464-023-10066-1. [PMID: 37081244 DOI: 10.1007/s00464-023-10066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/01/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Accurate division of bile duct during laparoscopic donor hepatectomy in living donor liver transplantation is essential. We here present a novel approach to achieve cholangiography via the bile duct stump of segment IV (B4 stump) during laparoscopic donor hepatectomy in adult-to-pediatric living donor liver transplantation. PATIENTS AND METHODS Donors who underwent laparoscopic left lateral sectionectomy (LLLS) from January 2022 to April 2022 in our liver transplant center were retrospectively analyzed. A total of 32 donors were eventually enrolled into this study. Cholangiography via the B4 stump was performed in 11 donors (B4 group) while indocyanine green (ICG) fluorescence guiding was performed in 21 donors (ICG group). Perioperative data were collected and compared between groups. RESULTS Cholangiography by catheterizing the B4 stump was successfully performed in all 11 donors in the B4 group. The mean time of this procedure was 12.82 ± 9.11 min. Compared to the ICG group, it was more likely to acquire single bile duct orifice on graft in the B4 group (B4: 10/11, 90.91% vs ICG: 9/21, 42.86%) and it was significantly different (p = 0.030). The donors' complications (Clavien-Dindo grade III-IV) were not significantly different. There was one donor developed intraperitoneal effusion in B4 group, while two donors (one bile leakage and one biliary stricture) developed biliary tract related complications in the ICG group. A Roux-en-Y was performed to solve the biliary stricture in the ICG group. The recipients' outcomes were not significantly different between groups. CONCLUSIONS Cholangiography via the B4 stump catheterization is feasible and safe in identifying the bifurcation of bile duct during LLLS.
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Affiliation(s)
- Hongyu Li
- Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Lin Wei
- Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Mingyue Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhigui Zeng
- Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Wei Qu
- Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhijun Zhu
- Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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The high-end range of biliary reconstruction in living donor liver transplant. Curr Opin Organ Transplant 2020; 24:623-630. [PMID: 31397730 DOI: 10.1097/mot.0000000000000693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To summarize recent evidence in literature regarding incidence and risk factors for biliary complications in living donor liver transplantation (LDLT), and current concepts in evaluation of donor biliary anatomy and surgical techniques of biliary reconstruction, to reduce the incidence of biliary complications. RECENT FINDINGS Advances in biliary imaging in the donor, both before surgery, and during donor hepatectomy, as well as safe hepatic duct isolation in the donor, have played a significant role in reducing biliary complications in both the donor and recipient. Duct-to-duct biliary anastomoses (DDA) is the preferred mode of biliary reconstruction currently, especially when there is a single bile duct orifice in the donor. The debate on stenting the anastomoses, especially a DDA, continues. Stenting a Roux en Y hepaticojejunostomy in children with small ductal orifices in the donor is preferred. With growing experience, and use of meticulous surgical technique and necessary modifications, the incidence of biliary complications in multiple donor bile ducts, and more than one biliary anastomoses can be reduced. SUMMARY Biliary anastomosis continues to be the Achilles heel of LDLT. Apart from surgical technique, which includes correct choice of type of reconstruction technique and appropriate use of stents across ductal anastomoses, better imaging of the biliary tree, and safe isolation of the graft hepatic duct, could help reduce biliary complications in the recipient, and make donor hepatectomy safe .
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Madeira-Cardoso MJ, Alexandrino H, Oliveira P, Rodrigues F, Oliveira AS, Vieira V, Oliveiros B, Tralhão JG, Carvalho H, Furtado E. Is Cholecystectomy Really Harmful? A Long-Term Quality of Life Study in Living Donor Liver Transplantation. Transplant Proc 2020; 52:873-880. [PMID: 32139276 DOI: 10.1016/j.transproceed.2020.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/18/2020] [Accepted: 01/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) is an accepted option for patients with end-stage liver disease. However, it potentially carries the risk of donor morbi-mortality, as well as long-term functional impairment. Cholecystectomy is performed routinely in the donor intervention, but the long-term effect on gastrointestinal (GI)-related quality of life (QoL) has never been explored previously. This study evaluated living donors' overall, abdominal wall-related, activity-level, and GI-related QoL. MATERIALS AND METHODS In total, 21 living liver donors (LLD) (57% women, mean age 45 ± 9 years) were compared to a control group (29 patients) undergoing cholecystectomy for gallbladder polyps (45% women, mean age of 46 ± 7 years). LLD and controls (Ctl) were divided into 2 age groups: LLD-Y and Ctl-Y (25-45 years); and LLD-O and Ctl-O (46-65 years). Generic SF-36, Gastrointestinal Quality of Life Index, EuraHS for abdominal wall status assessment, and International Physical Activity Questionnaire were performed. Standard age-adjusted Portuguese population SF-36 scores were used. RESULTS Global QoL results were better than Portuguese population scores and not inferior when compared to controls, scoring higher in the LLD-Y group in domains as vitality and mental health (P < .05). The abdominal wall impact was minimal among LLD. The activity level was significantly higher in LLD-Y than in Ctl-Y. Overall GI-related QoL was very close to the maximum score, and GI symptoms were significantly less in LLD-O compared with Ctl-O. CONCLUSION LDLT had no impact on donors' general, abdominal wall-related QoL or activity level. The performance of cholecystectomy apparently had no impact on the development of GI-related symptoms.
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Affiliation(s)
| | - Henrique Alexandrino
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Surgery Department, University Hospital of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research, University of Coimbra, Coimbra, Portugal
| | - Pedro Oliveira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Pediatric and Adult Liver Transplantation Department, University Hospital of Coimbra, Coimbra, Portugal
| | | | - Ana Sofia Oliveira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Surgery Department, University Hospital of Coimbra, Coimbra, Portugal
| | - Vera Vieira
- Surgery Department, Hospital of Figueria da Foz, Figueria da Foz, Portugal
| | - Bárbara Oliveiros
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research, University of Coimbra, Coimbra, Portugal
| | - José Guilherme Tralhão
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Surgery Department, University Hospital of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research, University of Coimbra, Coimbra, Portugal
| | - Hélder Carvalho
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Surgery Department, University Hospital of Coimbra, Coimbra, Portugal
| | - Emanuel Furtado
- Pediatric and Adult Liver Transplantation Department, University Hospital of Coimbra, Coimbra, Portugal
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