In pediatric liver transplantation,both for cadaveric and living related cases, Roux-en-Y hepaticojejunostomy is often preferred for biliary reconstruction. Duct-to-duct biliary reconstruction in pediatric patients is presented in very limited numbers in some studies. We retrospectively reviewed our experiences with duct-to-duct biliary reconstruction in pediatric liver transplantation patients. Since September 2003, 46 liver transplantations were performed for 44 patients (29 boys and 15 girls; mean age, 8.4±5.5 years old). For anastomoses, a corner-saving suture technique was used with 6-0 or 7-0 polypropylene monofilament nonabsorbable suture. In 3 patients, a T-tube, and in 11 patients, a straight feeding tube, was inserted from the recipient common bile duct to the anastomotic site, and transhepatic biliary catheter insertion technique was used in 28 patients for external bile drainage. The remaining 4 patients had no tubes or stents. Four patients developed bile leakage in the early postoperative period. Three of these 4 patients were treated with percutaneous drainage with excellent outcome. The 1 remaining patient required reoperation for bile leakage, and a Roux-en-Y hepaticojejunostomy was performed. Four biliary stenoses occurred in the late postoperative period. All biliary stenoses were successfully treated with balloon dilatation. There was no morbidity and no graft loss owing to biliary complications. Eight patients died during follow-up (2 to 34 months); 36 (82%) are doing well,with optimal liver function. In conclusion, our results show that duct-to-duct biliary reconstruction is a safe and easy technique for biliary reconstruction even in pediatric cases.