Biliary Reconstruction Techniques: From Biliary Tumors to Transplantation

Part of the Updates in Surgery book series (UPDATESSURG)


The performance of biliary reconstruction for restoring bilioenteric continuity after bile duct resection for hepatopancreatobiliary (HPB) tumors or during liver transplantation represents a basic skill for HPB and transplant surgeons. Such reconstruction may involve duct-to-duct anastomosis (or choledochocholedochostomy) or bilioenteric anastomosis, depending on the underlying disease, anatomy and indications. This chapter will describe the techniques of duct-to-duct and bilioenteric anastomoses focusing on their basic principles, techniques and application in oncological HPB surgery and liver transplantation.


Biliary reconstruction Hepaticojejunostomy Cholangiojejunostomy Duct-to-duct anastomosis Hepatopancreatobiliary tumors Choledochocholedochostomy Bile duct resection Ductoplasty Liver transplantation 

Supplementary material

Video 7.1

(MOV 365900 kb)


  1. 1.
    Ahrendt SA, Pitt HA. A history of the bilioenteric anastomosis. Arch Surg. 1990;125:1493–500.CrossRefGoogle Scholar
  2. 2.
    Quattlebaum JK, Quattlebaum JK Jr. Malignant obstruction of the major hepatic ducts. Ann Surg. 1965;161:876–89.CrossRefGoogle Scholar
  3. 3.
    Starzl TE, Marchioro TL, Vonkaulla KN, et al. Homotransplantation of the liver in humans. Surg Gynecol Obstet. 1963;117:659–76.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Starzl TE, Putnam CW, Ishikawa M, et al. Current policies in hepatic transplantation: candidacy of patients with alcoholic liver disease or preformed antidonor antibodies and a reappraisal of biliary duct reconstruction. Ann N Y Acad Sci. 1975;252:145–58.CrossRefGoogle Scholar
  5. 5.
    Calne RY. A new technique for biliary drainage in orthotopic liver transplantation utilizing the gall bladder as a pedicle graft conduit between the donor and recipient common bile ducts. Ann Surg. 1976;184:605–9.CrossRefGoogle Scholar
  6. 6.
    Starzl TE, Iwatsuki S, Van Thiel DH, et al. Evolution of liver transplantation. Hepatology. 1982;2:614–36.CrossRefGoogle Scholar
  7. 7.
    Jarnagin WR. Blumgart’s surgery of the liver, pancreas and biliary tract (e-book). Philadelphia, PA: Elsevier Health Sciences; 2016. p. 2120.Google Scholar
  8. 8.
    Brunner M, Stockheim J, Krautz C, et al. Continuous or interrupted suture technique for hepaticojejunostomy? A national survey. BMC Surg. 2018;18:84. Scholar
  9. 9.
    Lee SG. A complete treatment of adult living donor liver transplantation: a review of surgical technique and current challenges to expand indication of patients. Am J Transplant. 2015;15:17–38.CrossRefGoogle Scholar
  10. 10.
    Duconseil P, Turrini O, Ewald J, et al. Biliary complications after pancreaticoduodenectomy: skinny bile ducts are surgeons’ enemies. World J Surg. 2014;38:2946–51.CrossRefGoogle Scholar
  11. 11.
    Nagino M, Nishio H, Ebata T, et al. Intrahepatic cholangiojejunostomy following hepatobiliary resection. Br J Surg. 2007;94:70–7.CrossRefGoogle Scholar
  12. 12.
    Fan ST, Lo CM, Liu CL, et al. Biliary reconstruction and complications of right lobe live donor liver transplantation. Ann Surg. 2002;236:676–83.CrossRefGoogle Scholar
  13. 13.
    Hirano S, Tanaka E, Tsuchikawa T, et al. Techniques of biliary reconstruction following bile duct resection (with video). J Hepatobiliary Pancreat Sci. 2012;19:203–9.CrossRefGoogle Scholar
  14. 14.
    Northover JM, Terblanche J. A new look at the arterial supply of the bile duct in man and its surgical implications. Br J Surg. 1979;66:379–84.CrossRefGoogle Scholar
  15. 15.
    Rouch DA, Emond JC, Thistlethwaite JR Jr, et al. Choledochocholedochostomy without a T tube or internal stent in transplantation of the liver. Surg Gynecol Obstet. 1990;170:239–44.PubMedGoogle Scholar
  16. 16.
    Davidson BR, Rai R, Kurzawinski TR, et al. Prospective randomized trial of end-to-end versus side-to-side biliary reconstruction after orthotopic liver transplantation. Br J Surg. 1999;86:447–52.CrossRefGoogle Scholar
  17. 17.
    Castaldo ET, Pinson CW, Feurer ID, et al. Continuous versus interrupted suture for end-to-end biliary anastomosis during liver transplantation gives equal results. Liver Transpl. 2007;13:234–8.CrossRefGoogle Scholar
  18. 18.
    Seehofer D, Eurich D, Veltzke-Schlieker W, Neuhaus P. Biliary complications after liver transplantation: old problems and new challenges. Am J Transplant. 2013;13:253–65.CrossRefGoogle Scholar
  19. 19.
    Scatton O, Meunier B, Cherqui D, et al. Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation. Ann Surg. 2001;233:432–7.CrossRefGoogle Scholar
  20. 20.
    Riediger C, Müller MW, Michalski CW, et al. T-tube or no T-tube in the reconstruction of the biliary tract during orthotopic liver transplantation: systematic review and meta-analysis. Liver Transpl. 2010;16:705–17.PubMedGoogle Scholar
  21. 21.
    Sun N, Zhang J, Li X, et al. Biliary tract reconstruction with or without T-tube in orthotopic liver transplantation: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol. 2015;9:529–38.CrossRefGoogle Scholar
  22. 22.
    Soin A, Pahari H, Goja S, et al. Targeting the Achilles’ heel of adult living donor liver transplant: corner-sparing sutures with mucosal eversion technique of biliary anastomosis. Liver Transpl. 2016;22:862–3.CrossRefGoogle Scholar
  23. 23.
    Shah SA, Grant DR, McGilvray ID, et al. Biliary strictures in 130 consecutive right lobe living donor liver transplant recipients: results of a western center. Am J Transplant. 2007;7:161–7.CrossRefGoogle Scholar
  24. 24.
    Wachs ME, Bak TE, Karrer FM, et al. Adult living donor liver transplantation using a right hepatic lobe. Transplantation. 1998;66:1313–6.CrossRefGoogle Scholar
  25. 25.
    Hwang S, Lee S-G, Sung K-B, et al. Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation. Liver Transpl. 2006;12:831–8.CrossRefGoogle Scholar
  26. 26.
    Qian YB, Liu CL, Lo CM, et al. Risk factors for biliary complications after liver transplantation. Arch Surg. 2004;139:1101–5.CrossRefGoogle Scholar
  27. 27.
    Vellar ID. The blood supply of the biliary ductal system and its relevance to vasculobiliary injuries following cholecystectomy. ANZ J Surg. 1999;69:816–20.CrossRefGoogle Scholar
  28. 28.
    Vellar ID. Preliminary study of the anatomy of the venous drainage of the intrahepatic and extrahepatic bile ducts and its relevance to the practice of hepatobiliary surgery. ANZ J Surg. 2001;71:418–22.CrossRefGoogle Scholar
  29. 29.
    Lee K-W, Joh JW, Kim SJ, et al. High hilar dissection: new technique to reduce biliary complication in living donor liver transplantation. Liver Transpl. 2004;10:1158–62.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of General Surgery and TransplantationNiguarda HospitalMilanItaly
  2. 2.School of Medicine and SurgeryUniversity of Milano-BicoccaMilanItaly

Personalised recommendations