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Long-term outcome of ischemic type biliary stricture after interventional treatment in liver living donors: a report of two cases.

Jung DH, Hwang S, Ha TY, Song GW, Kim KH, Ahn CS, Moon DB, Park GC, Jung BH, Kwang SH, Lee SG - Korean J Hepatobiliary Pancreat Surg (2015)

Bottom Line: After keeping the tube for 2 months, the tube was successfully removed in one donor.On follow-up over 10 years, they are doing well so far with no recurrence of biliary stricture.Based on our limited experience, interventional treatment with subsequent long-term follow-up appears to be an essential and choice treatment for ischemic type biliary stricture occurring in liver living donors.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
The wall of normal proximal bile duct is occasionally thin with close approximation to the right hepatic artery. Thus, isolation of this hepatic artery can result in excessive weakening of the remnant proximal bile duct wall during hemiliver graft harvest. This type of injury can induce ischemic stricture of the donor common bile duct. This study aimed to review the clinical sequences of such ischemic type donor bile duct injuries primarily managed with endoscopic and radiological interventional treatments. A retrospective review of medical records was performed for two living donors who suffered from ischemic type donor bile duct injury. They were followed up for more than 10 years. The right and left liver grafts were harvested from these two donors. Bile duct anatomy was normal bifurcation in one and anomalous branching in the other. Bile duct stenosis was detected in them at 2 weeks and 1 week after liver donation. They underwent endoscopic balloon dilatation and temporary stent (endoscopic retrograde biliary drainage tube) insertion. After keeping the tube for 2 months, the tube was successfully removed in one donor. However, endoscopic treatment was not successful, thus additional radiological intervention was necessary in the other donor. On follow-up over 10 years, they are doing well so far with no recurrence of biliary stricture. Based on our limited experience, interventional treatment with subsequent long-term follow-up appears to be an essential and choice treatment for ischemic type biliary stricture occurring in liver living donors.

No MeSH data available.


Related in: MedlinePlus

Clinical sequences in a donor following right liver hepatectomy with operative findings (A), at the time of diagnosis of biliary stricture after 2 weeks (B), at the time of resolution of biliary stricture after 2 months (C), and long-term follow-up findings after 10 years (D).
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Figure 1: Clinical sequences in a donor following right liver hepatectomy with operative findings (A), at the time of diagnosis of biliary stricture after 2 weeks (B), at the time of resolution of biliary stricture after 2 months (C), and long-term follow-up findings after 10 years (D).

Mentions: The donor was a 33-year-old son of the recipient. He donated his right liver in November 2000. The remnant left liver volume was 34% of the total liver volume. The donor had a replacing right hepatic artery from the superior mesenteric artery. This right hepatic artery was firmly attached to the bile duct. Thus, extensive dissection was necessary to isolate this hepatic artery from the bile duct. Unusual right liver graft harvest was performed. Completion intraoperative cholangiogram showed no abnormal findings (Fig. 1A). The patient was discharged uneventfully. However, at 14 days after the surgery, the patient visited an outpatient clinic with obstructive jaundice detected. After confirmation of intrahepatic duct dilatation on computed tomography (CT) follow-up, endoscopic retrograde cholangiography (ERC) showed diffuse stenosis of the common bile duct. Endoscopic balloon dilatation was carried out and a temporary stent (endoscopic retrograde biliary drainage [ERBD]) was inserted (Fig. 1B). After 2 months, the biliary stenosis disappeared completely. Thus, the ERBD tube was removed (Fig. 1C). The patient was followed up regularly for more than 10 years. The last follow-up was performed in August 2012, in which the donor showed completely normal liver function with only mild intrahepatic ductal dilatation on liver ultrasonography (Fig. 1D).


Long-term outcome of ischemic type biliary stricture after interventional treatment in liver living donors: a report of two cases.

Jung DH, Hwang S, Ha TY, Song GW, Kim KH, Ahn CS, Moon DB, Park GC, Jung BH, Kwang SH, Lee SG - Korean J Hepatobiliary Pancreat Surg (2015)

Clinical sequences in a donor following right liver hepatectomy with operative findings (A), at the time of diagnosis of biliary stricture after 2 weeks (B), at the time of resolution of biliary stricture after 2 months (C), and long-term follow-up findings after 10 years (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494080&req=5

Figure 1: Clinical sequences in a donor following right liver hepatectomy with operative findings (A), at the time of diagnosis of biliary stricture after 2 weeks (B), at the time of resolution of biliary stricture after 2 months (C), and long-term follow-up findings after 10 years (D).
Mentions: The donor was a 33-year-old son of the recipient. He donated his right liver in November 2000. The remnant left liver volume was 34% of the total liver volume. The donor had a replacing right hepatic artery from the superior mesenteric artery. This right hepatic artery was firmly attached to the bile duct. Thus, extensive dissection was necessary to isolate this hepatic artery from the bile duct. Unusual right liver graft harvest was performed. Completion intraoperative cholangiogram showed no abnormal findings (Fig. 1A). The patient was discharged uneventfully. However, at 14 days after the surgery, the patient visited an outpatient clinic with obstructive jaundice detected. After confirmation of intrahepatic duct dilatation on computed tomography (CT) follow-up, endoscopic retrograde cholangiography (ERC) showed diffuse stenosis of the common bile duct. Endoscopic balloon dilatation was carried out and a temporary stent (endoscopic retrograde biliary drainage [ERBD]) was inserted (Fig. 1B). After 2 months, the biliary stenosis disappeared completely. Thus, the ERBD tube was removed (Fig. 1C). The patient was followed up regularly for more than 10 years. The last follow-up was performed in August 2012, in which the donor showed completely normal liver function with only mild intrahepatic ductal dilatation on liver ultrasonography (Fig. 1D).

Bottom Line: After keeping the tube for 2 months, the tube was successfully removed in one donor.On follow-up over 10 years, they are doing well so far with no recurrence of biliary stricture.Based on our limited experience, interventional treatment with subsequent long-term follow-up appears to be an essential and choice treatment for ischemic type biliary stricture occurring in liver living donors.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
The wall of normal proximal bile duct is occasionally thin with close approximation to the right hepatic artery. Thus, isolation of this hepatic artery can result in excessive weakening of the remnant proximal bile duct wall during hemiliver graft harvest. This type of injury can induce ischemic stricture of the donor common bile duct. This study aimed to review the clinical sequences of such ischemic type donor bile duct injuries primarily managed with endoscopic and radiological interventional treatments. A retrospective review of medical records was performed for two living donors who suffered from ischemic type donor bile duct injury. They were followed up for more than 10 years. The right and left liver grafts were harvested from these two donors. Bile duct anatomy was normal bifurcation in one and anomalous branching in the other. Bile duct stenosis was detected in them at 2 weeks and 1 week after liver donation. They underwent endoscopic balloon dilatation and temporary stent (endoscopic retrograde biliary drainage tube) insertion. After keeping the tube for 2 months, the tube was successfully removed in one donor. However, endoscopic treatment was not successful, thus additional radiological intervention was necessary in the other donor. On follow-up over 10 years, they are doing well so far with no recurrence of biliary stricture. Based on our limited experience, interventional treatment with subsequent long-term follow-up appears to be an essential and choice treatment for ischemic type biliary stricture occurring in liver living donors.

No MeSH data available.


Related in: MedlinePlus