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Response to Tamura et al.: Choledochotomy in live liver donors

We wish to thank Tamura et al. for their letter that emphasizes an important principle in living donation: minimize donor complications. However, they failed to understand that the small anterior longitudinal choledochotomy is safer not only for the recipient, but also for the donor, by precisely defining the biliary anatomy. We think it is important to distinguish the complications related to the transection of the right hepatic duct and complications related to the choledochotomy described in our article. No published series is immune from biliary complications in the donor, some including the need for reoperation. These complications are intrinsic to the nature of the surgery and independent from the technique used. On the other hand, no complications have ever occurred at the site or as a consequence of the anterior longitudinal choledochotomy described in our technique at a minimum follow-up of 18 months. Moreover, the same technique has been applied in more than 80 donors since 1998 at the University of Essen; even in that series, with a minimum follow-up of 3 yr, no complications at the site of the choledochotomy have been diagnosed. We agree that a word of caution is necessary when any invasive procedure in the donor operation is proposed. We also believe that hard data must be submitted prior to defining as “unnecessarily invasive” a minimal choledochotomy that in some occasions optimizes the transaction of the hepatic duct for both the donor and recipient.