Background:Biliary complications remain the Achilles's heel of LDLT, especially in the setting of multiple ducts in the right lobe graft. Hilar plate glissonian sheath preservation and careful anastomotic techniques have been described to reduce this complication. Ductoplasty is used infrequently due to fear of causing ductal wall ischemia due to tension, if ducts are more than 3 mm apart. We have a policy of Hilar plate Glissonian sheath approach for graft duct division and the site of duct division is aimed at minimizing donor biliary problems, resulting in multiple ducts on the graft side. We utilise ductoplasty and standard anastomosis based on chief operating surgeon's preference.

Aims: Compare biliary complications in right lobe living donor grafts with multiple ducts using ductoplasty vs. standard duct to duct anastomosis (DDA). Methods:Between March 2013 to 2015 October, 78 patients had a successful LDLT using a right lobe. 8 were excluded; 1 dual lobe, 7 bilioenteric reconstruction( isolated / combined with duct to duct anastomosis). Ductoplasty was performed using interrupted 6'0 PDS with knots outside and a small “v” excised from adjacent duct walls. The distance between ducts (range 2-7 mm)was not considered as a factor if ducts could be approximated without tension. The number of ducts ranged from 2-4 (median 2).For standard DDA, no attempt was made to approximate the ducts, rather both anterior and posterior wall sutures were taken through duct lumen and through the intervening hilar plate connective tissue in between the ducts. Results: 11 patients had a single duct orifice and were excluded (no biliary complications),while >1 duct was present in 59 cases. Follow up duration ranger from( 1 mth to 28 mth).Biliary complications(leak / stricture) were seen in 12, (27.9 %) of 43 recipients with standard DDA compared to 2 (12.5%)of 16 recipients with ductoplasty. Conclusion: Despite the retrospective nature and potential selection bias in the present series, Ductoplasty proveds similar or better results than standard DDA in multiple ducts right lobe grafts.Interductal distance may be insignificant if excess tension can be avoided and orientation of ducts maintained to avoid kinking with increase in graft volume in the next few weeks. Ducts which cannot be approximated with ease may be better managed by biliioenteric / combnined / separate anastomosis using recipient right and left duct orifices.

CITATION INFORMATION: Kapoor S, Varma V, Nath B, Kumaran V. Outcomes of Ductoplasty in Right Lobe Living Donor Grafts with More Than One Bile Duct. Am J Transplant. 2016;16 (suppl 3).

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