Bilateral duct-to-duct anastomosis in dual left graft living donor liver transplantation: Bile duct position assessment after graft procurement and perfusion - a retrospective cohort study.

Although bilateral duct-to-duct preserves endoscopic access and avoids enteric reconstruction, no structured intraoperative strategy has been established.

From 36 consecutive dual left graft living donor liver transplantation procedures, we propose a practical approach based on bile duct-portal vein positional patterns and a two-stage intraoperative assessment.

Biliary stricture occurred in 38.5% and was managed endoscopically in 88.9% without surgical reintervention.