Background: Biliary complications can result in a significant morbidity for split liver graft recipients. The segmental biliary anatomy, particularly the left biliary system is poorly defined. The anatomy of Segment 1 and 4 ductal drainage is highly variable and could be the source of bile leak for left lateral segment (LLS) split liver grafts. Use of a bench cholangiogram (BC) can be helpful to accurately identify the number and drainage pattern of segmental biliary system. This information further guides the line of parenchymal transection and identify significant biliary radicles that needs ligation to reduce biliary complications. A BC is routinely performed during a deceased split liver procedure at our institute. The aim of the study is 1) to assess the incidence of variant biliary anatomy with particular attention to Segment 1 and 4 ducts and 2) to evaluate the clinical relevance of routine bench cholangiogram in LLS grafts.

Methods: 100 bench cholangiograms between January 2009 and January 2015 were analysed. The images were reviewed by two surgeons and the biliary anatomy was compared using Huang and Busuttil's classification for right and left systems respectively. The standard line of parenchymal transection is 1cm to the right of falciform ligament and any deviations based on the information from BC was noted.

Results: A standard left ductal system was noted in 45 (45%) cases. The left bile duct anatomy was outside the Busuttil's classification in 22 cases (22%). BC results guided the line of parenchymal transection to obtain a single Segment 2&3 duct in 15 cases. The cut-surface of left lateral segment had a common Segment 2&3 duct in 88 cases (88%). A surgical intervention in the form of suture ligation of significant Segment 1/4 duct at bench preparation was performed in 6 cases. No bile leaks were noted in this cohort.

Conclusion: BC is a useful tool to guide liver parenchymal transection and potentially reduce the incidence of biliary complications. The anatomy of left biliary system is highly variable. A new classification including segment 1 ductal anatomy is needed for split liver procedure.

CITATION INFORMATION: Battula N, Anbarasan R, Thumma V, Sharif K, Perera T, Muiesan P, Mirza D. Utility of a Routine Bench Cholangiogram for Deceased Split Liver Procedure. Am J Transplant. 2016;16 (suppl 3).

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