Influence of technical refinement on biliary complications of donors of living donor liver transplantation: a retrospective comparative study

Background: Biliary complications (BCs) of living liver donors are of serious concern as they threaten the donor’s health and life. Technical problems are the main cause of these complications. Aim: We conducted a retrospective analysis of the incidence, types, and management polices of BCs in our cohort of donors of living donor liver transplantation, with special emphasis on the impact of technical refinement of bile duct stump closure. Patients and methods: Data were reviewed from a prospectively maintained database of all donors who underwent hepatectomy. The incidence and types of and management options for BCs in living liver donors were compared in two successive phases of our program of livingdonor liver transplantation.The first periodincluded140donors ina procedure in which the bile duct stumpwas closed using continuous sutures or interrupted sutures, whereas thesecondperiodcomprised100donors inaprocedurein whichthe bileduct stump was closed using a newly designed technique by combining suturing and reinforcement with a metallic clip just belowthe suture line.Before abdominal closure, the intraoperative cholangiogram was repeated. Results: The overall incidence of BCs among donors was 14.2%. On comparison of BCs in the two studied phases we found significant differences in the rate of BCs: 20% in the first phase and 6% in the second phase. Further, a significant difference was documented in the two periods with respect to age less than 30 years, male donors, BMI more than 25%, left lobe or left lateral graft, and one duct (P 0.05). Moreover, there were significant differences between the two periods regarding operative time, length of ICU stay, and length of hospital stay. Conclusion: Our newly adopted technique of bile duct stump closure as well as the performance of two intraoperative cholangiographies before cutting and after closure of the stump resulted in significant improvement in and reduction of BCs. This new technique is safe, simple, and reproducible and does not prolong the surgery.