Multiple bile ducts: do the duct distance and the number of biliary anastomosis have an impact on the recipient's biliary problems?

Introduction: The variation of multiple bile ducts in a living donor graft can be encountered frequently but whether or not this leads to biliary complications has not been known yet. Especially a duct distance between the bile duct and the number of biliary anastomosis has not been known to the risk of the recipient's complication. Method: From 316 patients who underwent living donor liver transplantation from 2011 to 2013, a total of 55 patients had more than 2 bile duct openings. Result: Forty-seven patients had 2 openings while 3 patients had 3 openings. Duct to duct anastomosis was done in 46 patients and 25 had tailored telescope reconstruction (TTR) while 29 patients had 1 or 2 internal stents placed. The average distance between the ducts was 5.8 mm. 25 patients were performed one biliary anastomosis using TTR method. Duct complication was not increased when the distance between ducts was longer. And the number of biliary anastomosis does not impact on complication. Conclusion: 8 patients from a total of 50 patients developed biliary complications showing a complication rate of 16%, which is not significantly high compared with complication rates with 1 duct opening in other articles. In the 2 bile duct group, duct distances is not significant that the longer distance between the ducts does not cause the worse outcomes as most would tend to expect. And TTR method could make one biliary anastomosis and it seems beneficial effect in small distance between the ducts.