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Intractable Rare Dis Res. 2019 Aug;8(3):214-216. doi: 10.5582/irdr.2019.01081.

Two-staged biliary reconstruction with temporary complete external biliary drainage as a bailout procedure in a pediatric patient after difficult living donor liver retransplantation.

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Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.


Biliary leakage at the site of the hepaticojejunostomy after liver transplantation is a life-threatening complication. We herein present the case of a 7-year-old girl who underwent complete external biliary drainage during difficult living donor liver retransplantation as a bailout procedure. The patient had undergone duct-to-duct biliary reconstruction in the initial living donor liver transplantation. In the retransplantation, Roux-en-Y (RY) reconstruction was planned but abandoned due to the critical condition in the operation. As an alternative procedure, the patient underwent complete external drainage using a 6Fr drainage tube with cuff. Five months after retransplantation when the nutrition status and physical strength of a patient recovered fully, RY hepaticojejunostomy was successfully performed. This is a case report of two-staged biliary reconstruction with temporary complete external biliary drainage used in pediatric liver retransplantation, which was performed after some months not a few days. It is a safe and feasible alternative when primary anastomosis is deemed to carry a high risk of bile leakage in cases of difficult liver transplantation in critically ill patients.


Living donor liver transplantation; Roux-en-Y hepaticojejunostomy; two-staged biliary reconstruction

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