الفهرس 
Anatomy of The Biliary SystemOnly 14 pages are availabe for public view
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Abstract
Biliary complications are the most common complications among donors for LDLT.
As mentioned, anatomic variations in the biliary tract appear to be one of the most important factors contributing to the higher incidence of biliary leakage among right-lobe donors (Yazumi et al., 2005).
As the anterior and posterior segmental branches of the RHD often diverge at a point that is immediately proximal to the bifurcation of the RHD and LHD, the RHD must be resected within a few millimeters of the bifurcation. In contrast, the LHD can be resected several millimeters beyond the bifurcation (Shio et al., 2008).
Furthermore, 40-60 % of right-lobe grafts have multiple biliary orifices. Right lobe donors also have larger biliary stumps than left-lobe donors (Yazumi et al., 2005).
The anatomical complexity of the biliary tract in right-lobe donors probably contributes to the fragility of the biliary stump, and consequently results in the higher rate of biliary leakage among these donors (Shio et al., 2008).
The outcome of the right-lobe donors with major biliary leakage is one of scenarios, donors with biliary leakage that is treated successfully and donors who developes biliary stricture after successful treatment of the leakage. Several factors may contribute to the development of post treatment biliary stricture in right-lobe donors, In a study, They discovered severe deformities in the biliary tract and a substantially smaller angle between the LHD and CHD in these donors (Shio et al., 2008).
It should be emphasized that, although the deformity in the left biliary tract could not be corrected in these donors, in most studies cholestasis improved after insertion of a 7- F endoprosthesis (Shio et al., 2008).
Taken together, these results indicate that postsurgical deformity in the bile duct and edema due to inflammation are the major factors in the development of stricture after effective treatment of biliary leakage (Shio et al., 2008).
Fig. (5): Mechanism for the development of recurrent biliary leakage or biliary stricture (A) The residual biliary system after the right lobe has been resected (B) With the compensatory hypertrophy of the residual left lobe, the hilum shifts into the vacant right subdiaphragmatic space. The angle between the left hepatic duct and the common hepatic duct consequently becomes smaller than it would immediately after left lobe resection. In addition, inflammation and infection around bifurcation due to biliary leakage immediately after donation would cause thickening of the bile duct wall and stenosis of the bile duct. Eventually, relapse of biliary leakage or biliary stricture would develop. F, the falciform ligament; P, pancreas. Arrows indicate the thickening of the bile duct wall and stenosis of the bile duct (Hasegawa et al., 2003).
These studies that we mentioned have demonstrated that the incidence of biliary complications is significantly higher in right-lobe donors than in left-lobe donors for LDLT.
Most donors (80%) whose biliary complications could not be treated conservatively were successfully treated by endoscopic treatment. Shio et al. conclude that endoscopic treatment of biliary complications is effective, and should be used as the first-line treatment for such complications in donors for LDLT (Shio et al., 2008).
With standardization of surgical technique, biliary complications can be minimized. Careful donor selection and avoiding preventable complications by meticulous attention to detail in the operative room can reduce morbidity and result in good outcomes (Pamecha et al., 2016).