Roux-en-Y hepatico-jejunostomy for a left segmental graft: Do not twist the loop, stick it!

Pediatr Transplant. 2015 Jun;19(4):358-65. doi: 10.1111/petr.12474. Epub 2015 Apr 16.

Abstract

Biliary complications remain a major challenge for long-term success after LT, as it is, as a rule, the most common technical - early and late - complication that occurs, and because these complications contribute to a significant number of late graft losses and retransplantations. In the pediatric age group, both biliary atresia, as the patient's condition, and the use of a left liver graft, obtained by a liver division technique, make it necessary for the use of a Roux-en-Y jejunal loop for the biliary reconstruction in the majority of cases. A slight modification of the technique is presented, consisting of a straight positioning along the cut surface (rather than the conventional position that results in a harpoon shape). A favorable outcome in terms of a technical complication and graft survival was observed. This way of doing this is an interesting variation and adds to the surgical armamentarium.

Keywords: biliary reconstruction; children; complications of liver transplantation; pediatric liver transplantation.

MeSH terms

  • Anastomosis, Roux-en-Y / methods*
  • Anastomosis, Surgical
  • Bile Ducts / surgery
  • Biliary Tract Surgical Procedures / methods
  • Child
  • Child, Preschool
  • Female
  • Graft Survival
  • Humans
  • Infant
  • Jejunostomy / methods*
  • Liver / surgery
  • Liver Transplantation / methods*
  • Magnetic Resonance Imaging
  • Male
  • Retrospective Studies