Biliary duct-to-duct anastomosis in living-related liver transplantation for both adult and pediatric recipients is recently used in our center. We described oue technique and early results of patients who underwent living-related liver transplantation with duct-to-duct anastomosis. Between January 2003 to July 2004, 34 patients underwent liver transplantation, giving the 88.2% patient and graft survival, in our center. Out of 34, 23 recipients (7 adult and 16 pediatric, 67.6%) underwent living related liver transplantation (LRLT) with duct-to-duct anastomosis with tube drainage technique. During recipient hepatectomy, the common bile duct was dissected and cut at the level of left and right hepatic bifurcation into the liver. A modified parachute technique with 7/0 polypropylene monofilament non-absosbable suture was used for anastomosis. In eight recipients (34.8%), T-tube and in 15 recipients (65%), straight feeding tube were used for external drainage, which inserted from the the recipient common bile duct. All straight feeding tube drains were fixed to the insertion point of the recipient common bile duct and to the second portion of duodenum with cat-gut suture. All biliary drains were removed in third post-transplantation month unless there is no catheter related complications or dislocation. Four patients died in the follow-up period (2 ARDS and 2 viral sepsis). Out of 34, 30 patients (88.2%) doing well with optimal liver functions in early post-transplantation period. In 23 LRLT patients with duct-to-duct anastomosis, only 3 patients diagnosed anastomotic leak (13.0%). However we observed short term bile leak in 6 patients (3 patients developed bile leak from graft cutting surface, 2 patients had bile leak from tube insertion point) which all treated conservatively. One patient’s bile duct anastomosis was seperated during his T-tube removal, who id treated conservatively with percutaneous bile drainage. All three patients, with anastomotic leak, also treated conservatively with excellent results. There is no re-operation or long term morbidity because of bile complication in our recipients.
According to our early results, giving 88.2% graft and patient survaival rate without major complication, we consider duct-to-duct anastomosis technique in partial or whole graft liver transplantation, when there is no tension effected to the anastomosis. Otherwise Roux-en-Y hepaticojejunostomy should be performed for decrease the risk of biliary complications.