En Bloc High Hilar Dissection Versus Conventional Hilar Dissection In Living Donor Liver Transplantation Donors: A Comparative, Single-Center Study

BackgroundLiving donor liver transplantation (LDLT) has become an accepted treatment option for end-stage liver disease. Biliary complications still remain a major concern and are considered the Achilles' heel of LDLT, with a morbidity ranging between 20 and 42.1%. The high incidence of biliary complications can be attributed mainly to the affection of the blood supply of bile ducts. The high hilar dissection technique was described aiming at preservation of bile duct vascular supply.Patients and methodsA total of 66 adult LDLT donors were operated in a single, liver transplant center (Ain Shams University Specialized Hospital) between January 2017 and August 2018. The study cases were divided into two groups: group A with conventional hilar dissection and group B with en bloc high hilar dissection. A comparative study was conducted between the two groups as regards early and late biliary complications.ResultsThe 66 LDLT donors were divided into two groups: group A included 33 donors with conventional hilar dissection and group B included 33 donors with en bloc high hilar dissection. The occurrence of postoperative biliary leak was significantly more in the conventional hilar dissection group (18.2%) compared with the en bloc high hilar dissection group (3.0%) (P=0.046).ConclusionThe en bloc high hilar dissection technique may decrease the incidence of biliary complications in LDLT donors as it protects the biliary vascular supply and facilitates the closure of the donor stump.