Tailored telescopic reconstruction of the bile duct in living donor liver transplantation.

Duct-to-duct reconstruction (DDR) of the bile duct has recently become the preferred choice in living donor liver transplantation (LDLT), but biliary complications still remain the most common cause of morbidity. We introduce our new technique of tailored telescopic reconstruction (TTR) of the bile duct for reducing bile duct complications in LDLT: the hilar plate covering the right and left hepatic ducts is bisected lengthwise through the right or left hepatic duct opening to make a funnel-shaped top, into which the donor hepatic duct is telescoped to match the recipient bile duct in size, and DDR is performed in the inner tissue of good vascular integrity of the recipient bile duct without redundancy. Forty-five consecutive LDLT procedures from January to August 2008 were analyzed through a comparison of 23 conventional duct-to-duct reconstructions (cDDRs) and 22 TTRs in bile duct anastomoses. At a mean follow-up of 19.5 months, the rates of overall biliary complications, leakage, and strictures were 43.5%, 26.1%, and 34.8%, respectively, for cDDR and 9.1%, 0%, and 9.1%, respectively, for TTR (P < 0.05 for each). In conclusion, TTR of the bile duct results in excellent outcomes with respect to minimization of biliary complications; thus, TTR can be recommended as a preferred method for biliary reconstruction in LDLT.