[Introduction of microvascular surgery to biliary reconstruction in living donor liver transplantation].

Objective: To explore the feasibility of introduction of microvascular surgery into biliary reconstruction in living donor liver transplantation (LDLT) so as to reduce the incidence of postoperative biliary complications.
Methods: The experience in the microvascular surgery performed on 32 patients undergoing LDLT, 8 children and 24 adults, including duct-to-duct anastomosis in 21 case, hepato-jejunostomy under surgical loupe in 13 cases, and hepato-jejunostomy under operative microscopy in 9 cases, totally 43 cases of biliary reconstruction manipulations.
Results: Post-operative biliary complications occurred in 2 patients. One male patient who underwent hepato-jejunostomy under surgical loupe suffered from leakage from a bilioenteric anastomotic stoma 3 days after operation and laparotomy was performed to repair the leakage and carry out drainage. Mild stricture of the anastomotic stoma occurred in the other patient 3 months after operation and conservative treatment was given. Both patients recovered.
Conclusion: Introduction of microvascular surgery to biliary reconstruction in LDLT, especially the use of operative microscopy for hepato-jejunostomy on very small hepatic ducts, <or= 2 mm in diameter, achieves good results, with significant reduction of post-operative complications.