Effect of Donors' Biliary Variation on Postoperative Biliary Complications in Living Donor Liver Transplantation: A Single-Center Observational Study in Vietnam.

BACKGROUND: Our study aims to evaluate the biliary anatomy variation according to the Varotti classification and its correlation with surgical outcomes for both donors and recipients undergoing living donor liver transplants (LDLTs). METHODS: A retrospective analysis of 150 LDLT cases performed at a single center in Vietnam with preoperative radiologic evaluations and intraoperative surgical assessments to identify biliary variant anatomy. Postoperative biliary complications were documented and analyzed. Statistical analysis was performed to determine any significant associations between biliary variations and post-transplant outcomes. RESULTS: One hundred fifty cases of LDLT at 108 Military Central Hospital from October 2017 to December 2022 were included in our study. Among the donors, the mean age was 30.89 ± 7.23, with male predominance (77.3%). The prevalence of type 1 biliary anatomy was 84.67%. Type 2, 3a, 3b, 4a, and 4b accounted for 5.33%, 2.67%, 5.33%, 0.67%, and 1.33% of cases, respectively. Donors' complications were witnessed in 7 cases (4.67%), and all needed intervention (Clavien-Dindo grade 3). Biliary complications were found in 36 (24.0%) recipients, with 22 (14.67%) cases of biliary stenosis and 16 (10.67%) cases of biliary leak, including 2 cases encountering both complications. Age, gender, graft type, preoperative liver function, biliary variant anatomy, number of graft orifices, Model for End-Stage Liver Disease score, and blood loss were not significant risk factors for recipients' biliary complications. Cold ischemia time significantly increased the biliary complication rate. CONCLUSIONS: This study shows that biliary variant anatomy is common in living liver donors. Such variations should not be a contraindication to liver donation. However, accurate pre- and intraoperative radiologic and surgical evaluations are fundamental for a careful reconstruction plan.

Hepatectomy with Takasaki's Technique Using SonaStar Ultrasonic Aspiration System: An Experience from 58 Cases.

OBJECTIVE: This study aims to explore the short-term results of hepatectomy with Takasaki's technique using Sonastar ultrasonic aspiration system. MATERIALS AND METHODS: We retrospectively examined data of 58 patients who underwent hepatectomy with Takasaki's technique using Sonastar ultrasonic aspiration system at Hue Central Hospital from 01/2018 to 02/2021. RESULTS: The mean age was 60.7 ± 10.5 years (25-80) and the male/female ratio was 6:1. Patients with solitary tumor accounted for 79%; 68.4% had tumor size greater than 5 cm. Pringle maneuver was used in 57.9%, while selective right or left Glissonean pedicle occlusion was used in 69.0% and 32.8%, respectively. Final transection surface reinforcement was achieved by Surgicel and BioGlue in 78.9% and 21.5% of cases, respectively. Major liver resection accounted for 73.7%. The mean parenchymal transection time was 50 (45-110) minutes, while mean total operative time was 125 (90-280) minutes. Mean operative blood loss was 250 (150-650) mL. Mean post-operative hospital stay was 8 days (7-23). Post-operative complication rate was 15.9% and mortality rate was 1.7%. CONCLUSION: Hepatectomy using Takasaki technique with Sonastar ultrasonic aspiration system is safe, effective, allowing an anatomical resection with sufficient safety margin and resulting in low complication rates (liver failure, biliary leakage) and good survival outcomes.