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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.

Three different standard types of liver bipartition producing six different types of grafts can be created by following a plane directed on the right or the left line of the middle hepatic vein (MHV): a) splitting for adult and pediatric recipients with left lateral graft (LLG) and right extended graft (REG), b) splitting for two adults or for adult and pediatric recipients of large size with creation of left graft (LG) and right graft (RG), c) splitting for two adult recipients with creation of full left graft (FLG) and full right graft (FRG). The absence of an extrahepatic portal vein bifurcation is an absolute contraindication to liver splitting. Division of the portal branches to Segment I optimizes the freeing/lengthening of the left portal vein for the implantation. Identifying the portal tract entering the caudate process at its lower aspect is helpful in preparing for the division of the hilar plate. Early division of the Arantius remnant allows a safe encircling and control of the left hepatic vein. During in situ splitting technique for adult and pediatric recipients, a 1–2-min. selective clamping of the left hepatic vein (LHV) may provide assurance that the hepatic venous drainage of Segment IV is not jeopardized. Recognition of independent segment II and III suprahepatic venous outflow (

In this Chapter we discuss the technical details of the right hemihepatectomy for living donor liver transplantation in adults by open technique. Successful donor outcome and the recipient’s hope for the highest probability of a successful transplant are relevant factors that ethically support the choice for living donor liver tranplantation.