Variations of the intrahepatic bile ducts: Application in living related liver transplantation and splitting liver transplantation

The variations in the anatomy of intrahepatic bile ducts complicate operations in living related liver transplantation (LRLT) and therefore preoperative delineation of the biliary system is important to achieve a successful outcome. The aim of this study was to establish a standard relationship between the biliary variations and the methods of the graft splitting and anastomosis. Of 958 endoscopic retrograde cholangiographies with good visualization of bile duct branches were selected and were available for evaluation of their ramifications and variants. According to drainage of right hepatic duct and left hepatic duct, we classified the bile ducts into two major groups. Unusual routes of the intrahepatic ducts were present in 105 cases (11% in group A) the right sectoral duct drained into the left hepatic duct directly; in 200 cases (21% in groups B) the duct of segment IV drained into right side or common hepatic duct; and in 29 cases (3% in groups B) the duct of segment II and III drained into the CBD and right hepatic duct separately. There is no specific bile duct variation that forbids someone from LRLT and SLT, but unusual intrahepatic ducts routes may require a change both in the cutting plane during graft retrieval and pattern of ductoenteral anastomosis to avoid potential complications to both donors and recipients. Cholangiography for screening intrahepatic duct variations is therefore important for safe bile drainage for both donors and recipients.