The Role of Bile Duct Probe for Bile Duct Division during Donor Right Hemihepatectomy

Soong June Bae; Dai Hoon Han; Gi Hong Choi; Jin Sub Choi

doi:10.4285/jkstn.2016.30.4.172

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Bae, Han, Choi, and Choi: The Role of Bile Duct Probe for Bile Duct Division during Donor Right Hemihepatectomy

Original Article

J Korean Soc Transplant 2016;30(4):172-177.

Published online: 19 January 2016

DOI: https://doi.org/10.4285/jkstn.2016.30.4.172

The Role of Bile Duct Probe for Bile Duct Division during Donor Right Hemihepatectomy

Soong June Bae, M.D., Dai Hoon Han, M.D., Gi Hong Choi, M.D., Jin Sub Choi, M.D.

Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

Corresponding author: Jin Sub Choi Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2228-2122, Fax: 82-2-2313-8289 E-mail: choi5491@yuhs.ac

Received 13 August 2016 Revised 8 October 2016 Accepted 5 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

To prevent bile duct related complications, exact division of donor bile duct is essential, not only for the recipient, but also for the donor during living donor liver transplantation. Cholangiography has been used for bile duct division during living donor right hemihepatectomy. This study was conducted to determine if bile duct probe could be used to replace cholangiography for bile duct division during living donor right hemihepatectomy.

Methods:

Surgical outcomes of 234 donors with right hemihepatectomy and duct to duct biliary anastomosis in living donor liver transplantation between January 2009 and December 2014 were retrospectively analyzed. A total of 85 donors used the bile duct probe for bile duct division during the right hemihepatectomy, whereas 149 donors used cholangiography. All donors underwent preoperative magnetic resonance cholangiopancreatography (MRCP).

Results:

The expected number of bile duct orifices based on MRCP did not differ significantly from the observed number of bile duct orifices after bile duct division (10 donors and five donors in each group were mismatched, P=0.238). The operation time was 384.7 minutes in the probe group, which was significantly shorter than that of the cholangiography group (400.4 minutes, P=0.041).

Conclusions:

Bile duct probing without intraoperative cholangiography might be a feasible procedure for bile duct division during living donor hemihepatectomy.

Keywords: Liver transplantation, Bile ducts, Anastomosis, Probe, Postoperative complications

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Fig. 1.

(A) Intraoperative view and (B) schematic view of bile duct probing method during donor right hemihepatectomy. The operator can decide the resection plan by tactile sensation under the direct vision using probing method.

Table 1.

Clinical feature of the donors

Variable	Operative cholangiography group	Probe only group	P-value
Sex			0.766
Male	101 (67.8)	56 (65.9)
Female	48 (32.2)	29 (34.1)
Age (yr)	31.77±10.77	30.58±10.78	0.418
BMI (kg/m²)	22.66±2.47	22.28±2.23	0.236
GRWR (%)	1.25±0.28	1.17±0.29	0.033
Preoperative bile duct no. (MRCP)			0.049
Single	108 (72.5)	51 (60.0)
Multiple	41 (27.5)	34 (40.0)
Operative time (min)	400.38±57.34	384.71±54.24	0.041

Data are presented as number (%) or mean±SD.

Abbreviations: BMI, body mass index; GRWR, graft recipient weight ratio; MRCP, magnetic resonance cholangiopancreatography.

Table 2.

Expected the number of bile duct orifice at magnetic resonance cholangiopancreatography

	Operative cholangiography	Probing method
Single opening	104 (69.8)	49 (57.6)
Multiple openings	45 (30.2)	36 (42.4)
P-value	0.060

Data are presented as number (%).

Table 3.

Number of opening bile duct orifice after bile duct division

	Operative cholangiography	Probing method
Match	144 (96.6)	80 (94.1)
Unmatched	5 (3.4)	5 (5.9)
P-value	0.503

Data are presented as number (%).

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