Background: Living donor liver transplantation has become an important treatment for end-stage liver disease. In living donor liver transplantation, the biliary tract is thinner and shorter than in deceased donor liver transplantation. For this reason, it has been reported that biliary complications are more frequent in living donor liver transplantation. We have been devising bile duct anastomosis to reduce bile leak and biliary stricture. In this study, we examined the results of our efforts and report the changes in the surgical technique and perioperative management at our hospital.

Methods: 210 patients who underwent living donor liver transplantation at our hospital by November 2021 were included in this study. Conventionally, biliary tract reconstruction was performed under direct vision with a circumferential interrupted suture and placement of an internal short stent. From March 2013 to May 2016, microsurgical outer knotted suture was used to reconstruct the biliary tract without sutured knots in the lumen. After a period of regression to the conventional method, since May 2019, biliary tract reconstruction has been performed with continuous sutures on the posterior wall and interrupted sutures on the anterior wall and external drainage as the basic stenting technique. 28 patients since May 2019 and 182 patients before May 2019 were divided into two groups. The incidence of bile leak and biliary stricture was examined. Risk factors for bile leak and biliary stricture were also examined in univariate and multivariate analysis.

Results: Among all patients, bile leak was observed in 29 cases and biliary stricture in 38 cases. In the current method group, there were 6 cases of bile leak and 4 cases of biliary stricture, with no significant difference between the two groups. Risk factors for bile leak were the number of reconstructed bile ducts and operative time in the univariate analysis. In multivariate analysis, only operative time was identified as an independent risk factor. Risk factors for biliary stricture were bile leak and operative time in the univariate analysis. In multivariate analysis, bile leak was identified as an independent risk factor for biliary stricture. Neither the current method of reconstruction nor the previous method were identified as risk factors.

Conclusion: In the present study, biliary tract reconstruction with continuous sutures on the posterior wall and interrupted sutures on the anterior wall and external drainage, which is currently performed at our hospital, showed no significant difference from conventional methods in both bile leak and biliary stricture. Because of the small number of cases, further study is needed in the future.