Is Cystic Duct Anastomosis a Suitable Option in the Presence of Double Bile Ducts in Living Donor Liver Transplantation?

Bile Duct Anastomosis in Liver Transplantation

Abstract

Background: The biliary duct anastomosis performed during living donor liver transplantation (LDLT) surgery is a critical surgical procedure that significantly influences postoperative patient mortality and morbidity. The aim of the present study was to evaluate the feasibility of utilizing the recipient's cystic duct along with the common bile duct in situations where biliary duct anastomosis becomes necessary.

Materials and Methods: In 16 of 49 liver transplants performed at Harran University Faculty of Medicine Organ Transplant Clinic between 2018 and 2021, the donor graft had double bile duct orifice. For the anastomosis of these bile ducts, the cystic duct was used along with the common bile duct in 9 patients, whereas in 7 patients, reconstruction was completed using various techniques without utilizing the cystic duct. Patients who underwent anastomosis to the cystic duct and those who underwent alternative techniques were evaluated in terms of difficulty and complications.

Results: Of the 16 patients included in the study, 7 (44%) were female and 9 (56%) were male. The mean age was 51.18 (±12.77) years. Anastomosis was performed to the cystic duct in nine patients. Regarding postoperative complications, among patients who underwent anastomosis to the cystic duct, only one developed bile leakage, which was treated with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous drainage. Complications developed in 3 of 7 patients in the other group. The two cases of bile duct strictures were treated with ERCP, while the bile leakage in one patient was conservatively monitored, and the leakage resolved spontaneously.

Conclusion: The utilization of the cystic duct in bile duct anastomosis in LDLT may offer advantages, especially in grafts with multiple and distant bile ducts. When preparing donors for LDLT, when multiple bile ducts are detected in the donor liver preoperatively or intraoperatively, it should be kept in mind that in cases with a narrow donor pool, the cystic duct can also be used in the anastomosis.