METHOD FOR BILIARY REPAIR IN GAUTIER'S ORTHOTOPIC TRANSPLANTATION OF LEFT LATERAL LIVER SECTOR IN CHILDREN WITH TRANSPLANT HAVING COMMON ORIFICE OF BILE DUCTS OF II AND III LIVER SEGMENTS

摘要

FIELD: medicine.;SUBSTANCE: end-to-side bioliodigestive anastomosis is created between a common orifice of bile ducts of the II and III liver segments of the transplant and recipient's Roux-defunctioned jejunal loop. When taking a left lateral liver sector from the donor, a round ligament of liver at least 7 cm long is left on the transplant. After forming an opening in an intestinal wall, an intestinal mucosa is fixed along the opening borders to a serous-muscular layer. An anastomosis is created between the opening formed in the intestine and the common orifice of bile ducts. The intestine is fixed to the transplant at a distance from the anastomosis angles. The round ligament of liver is laid on an anterior lip of the anastomosis, and a distal end of the ligament is fixed to the transplant. For particular cases: the common orifice is dilated by dissecting a bile wall within the common orifice by 2-4 mm along a pathfinder 1-1.5 mm in diameter inserted preliminary into the common orifice. An opening is formed in an antimesenteric edge of the intestine. The mucous membrane is fixed to the serous-muscular layer along the intestinal opening borders with 3-6 single interrupted sutures. The biliodigestive anastomosis is formed with single interrupted sutures. Fixing the intestine is ensured by anchoring together with the serous-muscular layer at 4-8 mm from each of the anastomosis angles to the liver capsule or a connective tissue plate, wherein the bile ducts of the transplant pass. A distal end of the round ligament of liver is fixed with one or two sutures to the liver capsule or connective tissue plate, wherein the bile ducts of the transplant pass. The distal end of the round ligament of liver is fixed to the transplant with the sutures fixing the intestine to the transplant. If the orifices of bile ducts of the transplanted II and III liver segments are arranged separately at min. 3 mm from each other, the adjoining bile walls are sutured together to create a common orifice that is followed by creating the biliodigestive anastomosis. Before forming the common orifice, at least one orifice of bile duct is dilated by dissecting its wall by 2-4 mm along a pathfinder 1-1.5 mm in diameter inserted preliminary into the orifice of bile duct.;EFFECT: method ensures preventing the inconsistency and strictures of the biliodigestive anastomosis.;10 cl