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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 left liver hepatectomy with operative findings (A), at the time of diagnosis of biliary stricture after 1 week (B), at the time of persistent biliary stricture after 4 months (C), and resolution of symptomatic biliary stricture after 10 months (D).
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Figure 2: Clinical sequences in a donor following left liver hepatectomy with operative findings (A), at the time of diagnosis of biliary stricture after 1 week (B), at the time of persistent biliary stricture after 4 months (C), and resolution of symptomatic biliary stricture after 10 months (D).

Mentions: The donor was a 27-year-old son of the recipient. He donated his left liver in January 2001. The donor had a type III portal vein anomaly with definitely variant bile duct configuration. Thus, the hilar bile duct was dissected extensively to prevent iatrogenic bile duct injury during graft bile duct transection. Usual left liver graft harvest was performed. Completion intraoperative cholangiogram showed no abnormal findings (Fig. 2A). However, at routine postoperative follow-up CT at 7 days, dilatation of the right posterior hepatic duct was detected without disturbance of liver function. Diffuse stenosis of the proximal right posterior duct and common bile duct were visualized on ERC. Thus, endoscopic balloon dilatation and ERBD tube insertion were performed (Fig. 2B). Since significant bile duct stenosis were left after two sessions of ERBD tube change for 4 months, a percutaneous transhepatic biliary drainage (PTBD) tube was finally inserted at 4 months after surgery (Fig. 2C). The PTBD tube was changed three times with serial dilatation and finally removed at 10 months after surgery (Fig. 2D). Although focal stenotic configuration of the bile duct was left, the patient showed completely normal function for more than 10 years after interventional treatment without recurrence of biliary stricture.


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 left liver hepatectomy with operative findings (A), at the time of diagnosis of biliary stricture after 1 week (B), at the time of persistent biliary stricture after 4 months (C), and resolution of symptomatic biliary stricture after 10 months (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Clinical sequences in a donor following left liver hepatectomy with operative findings (A), at the time of diagnosis of biliary stricture after 1 week (B), at the time of persistent biliary stricture after 4 months (C), and resolution of symptomatic biliary stricture after 10 months (D).
Mentions: The donor was a 27-year-old son of the recipient. He donated his left liver in January 2001. The donor had a type III portal vein anomaly with definitely variant bile duct configuration. Thus, the hilar bile duct was dissected extensively to prevent iatrogenic bile duct injury during graft bile duct transection. Usual left liver graft harvest was performed. Completion intraoperative cholangiogram showed no abnormal findings (Fig. 2A). However, at routine postoperative follow-up CT at 7 days, dilatation of the right posterior hepatic duct was detected without disturbance of liver function. Diffuse stenosis of the proximal right posterior duct and common bile duct were visualized on ERC. Thus, endoscopic balloon dilatation and ERBD tube insertion were performed (Fig. 2B). Since significant bile duct stenosis were left after two sessions of ERBD tube change for 4 months, a percutaneous transhepatic biliary drainage (PTBD) tube was finally inserted at 4 months after surgery (Fig. 2C). The PTBD tube was changed three times with serial dilatation and finally removed at 10 months after surgery (Fig. 2D). Although focal stenotic configuration of the bile duct was left, the patient showed completely normal function for more than 10 years after interventional treatment without recurrence of biliary stricture.

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