Title: Magnet compression anastomosis for bile duct stenosis after duct-to-duct biliary reconstruction in living donor liver transplantation
Abstract: Liver TransplantationVolume 11, Issue 4 p. 473-475 ImagesFree Access Magnet compression anastomosis for bile duct stenosis after duct-to-duct biliary reconstruction in living donor liver transplantation Hideaki Okajima, Corresponding Author Hideaki Okajima [email protected] Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan Telephone: 81-96-373-5615; FAX: 81-96-373-5616Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, 1-1-1 Honjo Kumamoto, 860-8556, JapanSearch for more papers by this authorAtsushi Kotera, Atsushi Kotera Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorTakayuki Takeichi, Takayuki Takeichi Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorMikako Ueno, Mikako Ueno Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorTaketoshi Ishiko, Taketoshi Ishiko Department of Gastroenterology & Hepatobiliary Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorMasahiko Hirota, Masahiko Hirota Department of Gastroenterology & Hepatobiliary Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorKatsuhiro Asonuma, Katsuhiro Asonuma Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorEijiro Yamauchi, Eijiro Yamauchi Department of Radiology, St. Marianna University School of Medicine, Yokohama City Hospital, Yokohama, JapanSearch for more papers by this authorYukihiro Inomata, Yukihiro Inomata Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this author Hideaki Okajima, Corresponding Author Hideaki Okajima [email protected] Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan Telephone: 81-96-373-5615; FAX: 81-96-373-5616Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, 1-1-1 Honjo Kumamoto, 860-8556, JapanSearch for more papers by this authorAtsushi Kotera, Atsushi Kotera Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorTakayuki Takeichi, Takayuki Takeichi Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorMikako Ueno, Mikako Ueno Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorTaketoshi Ishiko, Taketoshi Ishiko Department of Gastroenterology & Hepatobiliary Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorMasahiko Hirota, Masahiko Hirota Department of Gastroenterology & Hepatobiliary Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorKatsuhiro Asonuma, Katsuhiro Asonuma Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this authorEijiro Yamauchi, Eijiro Yamauchi Department of Radiology, St. Marianna University School of Medicine, Yokohama City Hospital, Yokohama, JapanSearch for more papers by this authorYukihiro Inomata, Yukihiro Inomata Department of Transplantation / Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, JapanSearch for more papers by this author First published: 21 March 2005 https://doi.org/10.1002/lt.20364Citations: 42 AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL A 44-year-old woman who had undergone living donor liver transplantation for fulminant hepatic failure presented obstructive jaundice 1 year after transplantation. A right lobe from her husband had been used for the original graft. Intraoperative cholangiography of the donor showed the bile duct of posterior inferior segment (B6) branching from the bile duct of anterior segment (Fig. 1). The bile duct of the donor was transected in the very short segment of the common trunk of the posterior and anterior branches of the right lobe. The orifice of the bile duct of the graft was single, but the shape of it was like the nose of a pig. This single orifice was anastomosed to the stump of the recipient's common hepatic duct. A biliary stent tube (4-French-sized) was inserted into only the bile duct of the posterior segment. Cold- and warm-ischemia time was 42 and 45 minutes, respectively. She initially recovered uneventfully in the early period after liver transplantation. The external stent tube was removed 3 months after the transplantation. Figure 1Open in figure viewerPowerPoint Intraoperative cholangiogram of the donor in the initial living donor liver transplantation. Bile duct of posterior inferior segment (B6) branching from the bile duct of the anterior segment Laboratory data at 11 months after the transplantation showed slight elevation of transaminases (aspartate aminotransferase: 80 IU/L, alanine aminotransferase: 100 IU/L) and total bilirubin (1.4 mg/dL). One month later, ultrasonography showed the dilated intrahepatic duct. Endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography disclosed the complete obstruction of the anterior branch (Fig. 2). The dilated duct was drained by the percutaneous transhepatic cholangiography drainage tube. Balloon dilatation was attempted though the percutaneous transhepatic cholangiography drainage tube, but it was not possible because the guidewire could not pass the stenosis. Relaparotomy with choledochojejunostomy was considered, but the patient strongly preferred the nonsurgical procedure. That is why the magnet compression anastomosis was applied. Figure 2Open in figure viewerPowerPoint (A) Percutaneous transhepatic cholangiography showed complete biliary obstruction of the anterior branch. (B) Endoscopic retrograde cholangiography could not show the anterior branch. Magnet Compression Anastomosis As preparation for the procedure, the percutaneous transhepatic cholangiography drainage tube had been gradually dilated by 2-French-size every week from 8 French to 18 French. The papilla Vateri had been also enlarged by the endoscopic sphincterectomy, A minor tranquilizer (diazepam 10 mg) was given to the patient prior to the procedure. The parent magnet (diameter 4 mm) attached to a guide with a covered tube was inserted into the common bile duct and placed at the common bile duct side of the stricture (Fig. 3). A 16-French-sized sheath tube was inserted through the dilated percutaneous transhepatic cholangiography drainage fistula, and the daughter magnet attached to a guide wire was inserted to the intrahepatic duct (Fig. 4A-B). The 2 magnets were immediately attracted toward each other, sandwiching the stricture (Fig. 4C) (Yamauchi procedure1, 2). The sheath tube was removed and changed to the indwelling porous percutaneous transhepatic cholangiography drainage tube. Establishment of the reanastomosis was assured by day 42 with radiological examinations (Fig. 5). The indwelling drainage tube was pushed and was inserted down to the common bile duct through the anastomosed stoma, as the internal stent tube maintained the patency. The stent tube was removed 3 months later. There has been no recurrence of the stricture in the 15 months of follow-up after the creation of the new stoma. Figure 3Open in figure viewerPowerPoint Placing of the parent magnet. (A) A parent magnet (diameter 4 mm) attached to a guide with covered tube was placed endoscopically through the papilla Vateri that was enlarged enough with endoscopic sphincterectomy at supine position. (B) The parent magnet was placed at the stricture point. Figure 4Open in figure viewerPowerPoint Placing of the daughter magnet. (A) The daughter magnet attached to a guide wire was inserted through the sheath tube. (B) The daughter magnet was placed into the obstructed intrahepatic duct. (C) The 2 magnets were immediately attracted toward each other. Figure 5Open in figure viewerPowerPoint Reanastomosis was established by day 42 after magnets were inserted. References 1 Takao S, Matsuo Y, Shinchi H, Nakajima S, Aikou T, Iseji T, et al. Magnetic compression anastomosis for benign obstruction of the common bile duct. Endoscopy 2001; 33: 988– 990. 2 Yamanouchi E, Kawaguchi H, Endo I, Arakawa H, Yamaguchi T, Sakuyama K, et al. A new interventional method: magnetic compression anastomosis with rare-earth magnets. Cardiovasc Intervent Radiol 1998; 21(Suppl 1): S155. Citing Literature Volume11, Issue4April 2005Pages 473-475 FiguresReferencesRelatedInformation