Technical Refinements of Bile Duct Division in Living Donor Liver Surgery

Background/purpose: In spite of the great risk involved, the donor bile duct division procedure has not been thoroughly addressed in the literature. The purpose of this study is to show the appropriate approach to bile duct division in living donor hepatectomy.

Methods: Of 87 living donor liver surgeries, we performed bile duct division by marking the cutting point using a small vascular clip under ordinary cholangiography in the first 37 patients, while the current procedure was used in 50 patients by encircling the cutting point using a radiopaque marker filament under real-time C-arm cholangiography.

Results: Regarding the procurement of the 51 right lobe grafts, the incidence of multiple bile ducts in the graft was significantly reduced by our novel procedure [20/28 (71%) vs. 7/23 (30%), P < 0.01, Fisher's test]. Overall, there were no biliary strictures after surgery in any of the donors, with a median follow-up period of 43 months (range 8-136).

Conclusions: Our procedure of bile duct division in living liver donor surgery enabled us to avoid the biliary stricture while cutting the bile duct of the donor with great accuracy.