Introduction : Optimal bile duct division line should prevent multiple orifices on the graft and biliary stricture of donors. Magnetic resonance cholagiopancreatography (MRCP) is used most commonly to assess donor bile ducts preoperatively. We have identified caudate branches arising from hilar bifurcation in MRCP. This study evaluated the feasibility of caudate branches shown in MRCP as anatomic landmark during bile duct division by confirming the location using probing method or operative cholangiogram.

Methods : From February 2016 to December 2017, 57 patients undergoing donor right hepatectomy were evaluated. Prospective data collection for location of caudate branches on MRCP and identification of corresponding caudate branches during operation was performed. Results of probing method or operative cholangiogram were also collected to confirm the anatomic landmark. Clinical characteristics and postoperative outcomes were evaluated.

Results : Preoperative evaluation of MRCP showed that 46 patients (81%) were possible candidates for single bile duct opening in the graft. Median distance from hilar bifurcation to right 2nd order division on MRCP was 8.5 mm (range: 3-16 mm). Operative outcomes showed 42 patients (74%) with single graft bile duct, 14 patients (25%) with two graft bile ducts and 1 patient (2%) with trifurcated graft bile ducts. Caudate branches were identified in 51 patients (89%). Caudate branches could not be found on MRCP for 4 patients. Probing method was found to be difficult in 12 patients (21%). There were no postoprerative biliary complications.

Conclusions : A caudate branch may be used as the anatomical landmark for optimal bile duct division during donor right hepatectomy.