Living donor hepatectomies with procedures to prevent biliary complications

Akinobu Taketomi, Kazutoyo Morita, Takeo Toshima, Kazuki Takeishi, Hiroto Kayashima, Mizuki Ninomiya, Hideaki Uchiyama, Yuji Soejima, Ken Shirabe, Yoshihko Maehara

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Biliary complications in donor hepatectomies are still common, and occur in approximately 5% of the procedures. Study Design: To evaluate the usefulness of the management and surgical procedures to prevent the biliary complications in donor hepatectomies, a total of 343 donors were retrospectively studied. The clinical and surgical parameters of the donors and the postoperative biliary complications were evaluated. Results: Fourteen donors had biliary complication (BC) during the follow-up period (4.1%). Donors were divided into 2 groups; donors without BC (non-BC group; n = 329) and donors with BC (BC group; n = 14). Mean peak level of total bilirubin, mean duration of hospital stay after surgery, and medical cost in the BC group were significantly higher than in the non-BC group (p < 0.01). As improved procedures to prevent the BC were established at 2005, including the use of a real-time cholangiography by the C-arm, a minimized dissection of the hepatic vessels, the meticulous closure of the bile duct, and/or the use of Pringle maneuver during the parenchymal transection, the donors were divided into 2 groups before and after these establishments (the early period, n = 173; the later period, n = 170). Refinements in the management and surgical procedures reduced the occurrence of biliary complications from 6.4% during the early period to 1.8% during the later period (p < 0.01), and no biliary complications in the last 69 consecutive donors were observed. Conclusions: Technical refinements described in this study might be useful to prevent the occurrence of biliary complications in a donor hepatectomy. It is particularly important to preserve the blood supply for the biliary tract of both the graft and the remnant liver.

Original languageEnglish
Pages (from-to)456-464
Number of pages9
JournalJournal of the American College of Surgeons
Volume211
Issue number4
DOIs
Publication statusPublished - Oct 1 2010

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Living Donors
Hepatectomy
Tissue Donors
Cholangiography
Liver
Biliary Tract
Bile Ducts
Bilirubin
Dissection
Length of Stay
Arm
Transplants
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Surgery

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Living donor hepatectomies with procedures to prevent biliary complications. / Taketomi, Akinobu; Morita, Kazutoyo; Toshima, Takeo; Takeishi, Kazuki; Kayashima, Hiroto; Ninomiya, Mizuki; Uchiyama, Hideaki; Soejima, Yuji; Shirabe, Ken; Maehara, Yoshihko.

In: Journal of the American College of Surgeons, Vol. 211, No. 4, 01.10.2010, p. 456-464.

Research output: Contribution to journalArticle

Taketomi, A, Morita, K, Toshima, T, Takeishi, K, Kayashima, H, Ninomiya, M, Uchiyama, H, Soejima, Y, Shirabe, K & Maehara, Y 2010, 'Living donor hepatectomies with procedures to prevent biliary complications', Journal of the American College of Surgeons, vol. 211, no. 4, pp. 456-464. https://doi.org/10.1016/j.jamcollsurg.2010.04.018
Taketomi, Akinobu ; Morita, Kazutoyo ; Toshima, Takeo ; Takeishi, Kazuki ; Kayashima, Hiroto ; Ninomiya, Mizuki ; Uchiyama, Hideaki ; Soejima, Yuji ; Shirabe, Ken ; Maehara, Yoshihko. / Living donor hepatectomies with procedures to prevent biliary complications. In: Journal of the American College of Surgeons. 2010 ; Vol. 211, No. 4. pp. 456-464.
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AU - Taketomi, Akinobu

AU - Morita, Kazutoyo

AU - Toshima, Takeo

AU - Takeishi, Kazuki

AU - Kayashima, Hiroto

AU - Ninomiya, Mizuki

AU - Uchiyama, Hideaki

AU - Soejima, Yuji

AU - Shirabe, Ken

AU - Maehara, Yoshihko

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N2 - Background: Biliary complications in donor hepatectomies are still common, and occur in approximately 5% of the procedures. Study Design: To evaluate the usefulness of the management and surgical procedures to prevent the biliary complications in donor hepatectomies, a total of 343 donors were retrospectively studied. The clinical and surgical parameters of the donors and the postoperative biliary complications were evaluated. Results: Fourteen donors had biliary complication (BC) during the follow-up period (4.1%). Donors were divided into 2 groups; donors without BC (non-BC group; n = 329) and donors with BC (BC group; n = 14). Mean peak level of total bilirubin, mean duration of hospital stay after surgery, and medical cost in the BC group were significantly higher than in the non-BC group (p < 0.01). As improved procedures to prevent the BC were established at 2005, including the use of a real-time cholangiography by the C-arm, a minimized dissection of the hepatic vessels, the meticulous closure of the bile duct, and/or the use of Pringle maneuver during the parenchymal transection, the donors were divided into 2 groups before and after these establishments (the early period, n = 173; the later period, n = 170). Refinements in the management and surgical procedures reduced the occurrence of biliary complications from 6.4% during the early period to 1.8% during the later period (p < 0.01), and no biliary complications in the last 69 consecutive donors were observed. Conclusions: Technical refinements described in this study might be useful to prevent the occurrence of biliary complications in a donor hepatectomy. It is particularly important to preserve the blood supply for the biliary tract of both the graft and the remnant liver.

AB - Background: Biliary complications in donor hepatectomies are still common, and occur in approximately 5% of the procedures. Study Design: To evaluate the usefulness of the management and surgical procedures to prevent the biliary complications in donor hepatectomies, a total of 343 donors were retrospectively studied. The clinical and surgical parameters of the donors and the postoperative biliary complications were evaluated. Results: Fourteen donors had biliary complication (BC) during the follow-up period (4.1%). Donors were divided into 2 groups; donors without BC (non-BC group; n = 329) and donors with BC (BC group; n = 14). Mean peak level of total bilirubin, mean duration of hospital stay after surgery, and medical cost in the BC group were significantly higher than in the non-BC group (p < 0.01). As improved procedures to prevent the BC were established at 2005, including the use of a real-time cholangiography by the C-arm, a minimized dissection of the hepatic vessels, the meticulous closure of the bile duct, and/or the use of Pringle maneuver during the parenchymal transection, the donors were divided into 2 groups before and after these establishments (the early period, n = 173; the later period, n = 170). Refinements in the management and surgical procedures reduced the occurrence of biliary complications from 6.4% during the early period to 1.8% during the later period (p < 0.01), and no biliary complications in the last 69 consecutive donors were observed. Conclusions: Technical refinements described in this study might be useful to prevent the occurrence of biliary complications in a donor hepatectomy. It is particularly important to preserve the blood supply for the biliary tract of both the graft and the remnant liver.

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