Question

In orthotopic liver transplantation, which is the best way to get bile drainage in the donor liver?

• A. Donor bile duct to recipient bile duct (duct-to-duct), or Roux-en-Y choledochojejunostomy
• B. Donor bile duct to duodenum of recipient
• C. Donor bile duct to jejunum of recipient
• D. External drainage for a few days followed by choledochojejunostomy

Hint:

Reconnect duct to duct when you can, Roux-en-Y when you cannot.

Answer 1

The Correct Option is A

The aim after sewing in the new liver is a leak-free, physiological route for bile to reach the bowel. The cleanest solution is to join the donor bile duct straight onto the recipient bile duct, an end-to-end duct-to-duct repair, because it keeps normal anatomy, retains the sphincter of Oddi, and leaves the duct reachable by ERCP for future intervention.

If the recipient's own duct cannot be used, such as in sclerosing cholangitis or with a marked size difference, surgeons switch to a Roux-en-Y choledochojejunostomy, bringing up a defunctioned jejunal limb to the donor duct.

The option that lists both the duct-to-duct repair and the Roux-en-Y alternative therefore covers standard practice. Hooking the duct to the duodenum is not done, a simple jejunal loop without a Roux limb invites reflux cholangitis, and routine temporary external drainage followed by delayed surgery is not the default plan.

$\text{first choice: duct-to-duct;\ backup: Roux-en-Y hepaticojejunostomy}$
\[\boxed{\text{Donor duct to recipient duct, or Roux-en-Y choledochojejunostomy}}\]