Background : Withdrawal from liver donation due to anatomical variations of the bile duct is an important consideration in living donor liver transplantation (LDLT), therefore, various techniques for biliary reconstruction have been developed to expand the living donor pool.

Methods : The authors report a successful LDLT using a right liver, whose donor had a vary narrow (〈1mm) accessory bile duct draining from right anterior section to common bile duct, which was far (14mm) from confluence of right and left main bile duct. The donor graft had two bile duct openings including right main duct and accessary duct. Separate duct-to-duct anastomoses were performed because of long distance between two openings. The main right duct orifice was anastomosed to the common bile duct of recipent in conventional method with stent insertion. For proper tension, we planed anastomosis of the accessary duct to cystic duct. Due to a sufficiently long accessory duct stump (8mm) and the size discrepancy of orfices diameter more than threefold, invagination of accessary duct stump into cystic duct was perfomed in dunking method. Suture was performed to fix the end of the accessary duct stump to inside of the cystic duct and the cystic duct orfice was fix to graft.

Results : The postoperative course of the recipient was stable with normal liver function at 6 months after LDLT.

Conclusions : Duct-to-duct anastomosis of a very narrow and long accessary duct to cystic duct using Dunkin’s technique could be an acceptable option for biliary reconstruction in LDLT.