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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Cholangiojejunostomy for multiple biliary ducts in living donor liver transplantation: A case report
Fei Xiao, Li-Ying Sun, Lin Wei, Zhi-Gui Zeng, Wei Qu, Ying Liu, Hai-Ming Zhang, Zhi-Jun Zhu
Fei Xiao, Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Fei Xiao, Department of Organ Transplantation, Liao Cheng People's Hospital, Liaocheng 252000, Shandong Province, China
Li-Ying Sun, Zhi-Jun Zhu, Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing 100050, China
Li-Ying Sun, Zhi-Jun Zhu, Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Capital Medical University, Beijing 100050, China
Li-Ying Sun, Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Lin Wei, Zhi-Gui Zeng, Wei Qu, Ying Liu, Hai-Ming Zhang, Zhi-Jun Zhu, Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Capital Medical University, Beijing 100050, China
Author contributions: Zhu ZJ, Sun LY, and Wei L contributed to study design; Zeng ZG, Qu W, and Liu Y contributed to data collection; Xiao F and Zhang HM contributed to data analysis and writing.
Supported by Capital's Funds for Health Improvement and Research, No. 2020-1-2024.
Informed consent statement: The patient provided informed verbal consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest in relation to this report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Zhi-Jun Zhu, MD, PhD, Chief Doctor, Surgeon, Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. zhu-zhijun@outlook.com
Received: December 12, 2020
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
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
