Which is the best way to get bile drainage in donor liver?
|A||Donor bile duct with recipient bile duct|
|B||Donor bile duct with duodenum of recipient|
|C||Donor bile duct with jejunum of recipient|
a. The donor and recipient bile ducts are anastomosed end to end using 6-0 PDS .
b. The anastomosis may be stented with at – tube .
c. The T – tube is removed after 3 months If there is a major discrepancy regarding size between donor and recipient duct or the recipient duct is diseased ( as in PSC) or too small , a choledochojejunostomy is performed.
d. The recipient common hepatic artery is anastomosed to the donor celiac axis .If artery flow is not adequate then a jump graft is taken of donor iliac or carotid artery
e. The portal vein cuff are fashioned and anastomosed end to end.
f. Caval anastomosis – the native suprahepatic caval cuff is fashioned and end to end anastomosis is performed with heavy running sutues. The intrahepatic cavl cuffs are fashioned similarly and anastomosed.