BILIARY RECONSTRUCTIONS AND COMPLICATIONS ENCOUNTERED IN 44 LEFT LATERAL SEGMENT LIVING DONOR LIVER TRANSPLANTATIONS IN CHILDREN
Makaleler > Tam Makale · 2006
Yazarlar: Sema AYDOĞDU, G Tumgor, C Arikan, HA Yuksekkaya, U Aydin, M Alper, M Zeytunlu, M Kilic
Journal of Pediatric Gastroenterology and Nutrition, Uluslararası, Wos, 2006, cilt 42
DOI: 10.1002/j.1536-4801.2006.tb01753.x
Özet
Biliary complications appear to be the leading cause of postoperative complications after living donor liver transplantation (LDLT). The aim of this study is to analyze the complications, treatment modalities, and outcome of biliary anastomoses in a series of 44 left lateral segment LDLTs. In this study we sought to determine the safety of roux - y biliary reconstruction in live donor left lateral segment LDLTs. 49 living related liver transplantation were performed to 48 pts in our center, and 44 of them were left lateral segment LDLTs. Median patient age was 4.1 years (range 6 months - 12 years). Median left lateral segment volume was 242.5 gr (range 80gr-to 365gr). Graft- recipient weight ratio was to 1.87. Median follow up time was 50 months (range 7 days to 69 months). 12 of 44 pts died, resulting in an overall allograft and patient survival rate of %72.7. In biliary reconstruction, standart Roux-en Y (R-Y) anastomosis was performed in all cases. 32 grafts (66%) had a single duct for anastomosis. 15 grafts (32 %) had two bile duct orifices, and 1 grafts (2%) had tree bile duct orifices. The overall incidence of biliary anastomotic complications was 18.6 % (8/43 pts) in these series. 2 pts (4.6%) developed biliary leaks, presumably from the cut surface, and all of them healed spontaneously. 2 bilomas (4.6%) were drained percutaneously. Anastomotic strictures occured in 4 pts (9.3%). Three of anastomotic strictures had a single duct, one of them had two bile duct orifices. There was not any arterial thrombosis or stenosis detected. The biliary complication rate decreased significiantly in the last 3 years as well as the other complications due to the learning curve effect of the complex procedure. All strictures were managed by percutaneous measures initially. Restenosis occurred in 2 patients and one required surgical revision of the biliary anastomosis. Giving a reoperation rate of 2.1% for biliary problems. Only one graft and patient was lost because of biliary problems and accompanying septic complications. Our data suggest that Roux en Y anastomosis is a safe and feasible method of biliary reconstruction in pediatric left lateral segment LDLTs.