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En Bloc Hilar Dissection of the Right Hepatic Artery in Continuity with the Bile Duct: a Technique to Reduce Biliary Complications After Adult Living-Donor Liver Transplantation

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Objective

Techniques that preserve the right hepatic artery and the common bile duct in continuity during the dissection may be associated with lower rates of biliary complications in living-donor liver transplants. This study sought to determine whether en bloc hilar dissections were associated with fewer biliary complications in living-donor liver transplants.

Methods

This was a retrospective review of 41 adult LDLTs performed in a single, liver transplant center between February 2007 and September 2014. The primary outcome of interest was the occurrence of at least one of the following biliary complications: anastomotic leak, stricture, or biloma. The primary predictor of interest was the hilar dissection technique: conventional hilar dissection vs. en bloc hilar dissection.

Results

A total of 41 LDLTs were identified, 24 had a conventional, and 17 an en bloc hilar biliary dissection. The occurrence of any biliary complication was significantly more common in the conventional hilar dissection group compared to the en bloc hilar dissection group (66.7 vs. 35.3 %, respectively, p = 0.047). In particularly, anastomotic strictures were significantly more common in the conventional hilar dissection group compared to the en bloc hilar dissection group (54.2 vs 23.5 %., respectively, p = 0.049).

Conclusion

En bloc hilar dissection technique may decrease biliary complication rates in living donor liver transplants.

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Abbreviations

ESLD:

end-stage liver disease

ERCP:

endoscopic retrograde cholangiopancreatography

LDLT:

living donor liver transplantation

PTC:

percutaneous transhepatic cholangiography

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Authors and Affiliations

  1. Division of Transplantation, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Dulles, Philadelphia, PA, 19104, USA

    Samir Abu-Gazala, Kim M. Olthoff, David S. Goldberg, Abraham Shaked & Peter L. Abt

Authors
  1. Samir Abu-Gazala
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  2. Kim M. Olthoff
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  3. David S. Goldberg
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  4. Abraham Shaked
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  5. Peter L. Abt
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Corresponding author

Correspondence to Samir Abu-Gazala.

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The Institutional Review Board of the Hospital of the University of Pennsylvania approved this study.

Conflict of Interest

The authors declare that they have no competing interests.

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Abu-Gazala, S., Olthoff, K.M., Goldberg, D.S. et al. En Bloc Hilar Dissection of the Right Hepatic Artery in Continuity with the Bile Duct: a Technique to Reduce Biliary Complications After Adult Living-Donor Liver Transplantation. J Gastrointest Surg 20, 765–771 (2016). https://doi.org/10.1007/s11605-015-3047-1

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  • DOI: https://doi.org/10.1007/s11605-015-3047-1

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