The children accepted a living liver transplant surgery in Colombian local hospital at 6 months old due to congenital biliary atresia related liver cirrhosis and decompensation. Because of portal vein thrombosis and biliary complications, she received another two surgical treatments after transplantation in the local hospital, including a portal vein intervention and a second operation of biliary reconstruction, respectively. For various reasons, the patient experienced repeated jaundice and abnormal liver function; meanwhile a huge incisional hernia appeared on the right side of the abdominal wall. The bile duct and vascular conditions of the child were too poor so that a number of hospitals recommended her to consider a second liver transplant surgery.

  

 Through the multiple inquires, the patient eventually came to Renji Hospital for medical treatment. By magnetic resonance cholangiopancreatography imaging a large branch of the bile duct was found in the left side of the liver, and the bile duct connected with the trunk, suggesting that the children had severe biliary obstruction and jaundice continued to rise. Director of Department of Liver Surgery of Renji Hospital, Professor Qiang Xia, conducted a multidisciplinary MDT discussion for the disease of the child with experts from Department of Transplantation, Department of Pediatric Surgery, Department of Radiology Intervention and others. The patient has three surgical histories and also severe abdominal adhesions. Because hilar anatomy is very difficult, the problem of bile duct obstruction delayed healing. Finally, the experts developed a new program for a third operation of biliary reconstruction for the patient.

  

 June 17, Qiang Xia’s team rebuilt the bile duct using unconventional surgical method. During the operation, Qiang Xia carefully dissected abdominal adhesions, and found the expanded bile duct after resection of the left part of the liver when retaining the original bile intestinal anastomosis. Then he rebuilt another bile drainage outlet through the expanded bile duct, and established another set of Rux-en-Y cholangioceal anastomosis in the retention of the original bile anastomosis to cleverly relieve the problem of biliary obstruction and incisional hernia for the patient. The operation was a complete success. The operation cleverly avoided the anatomical separation of the hilar, and established bile drainage channels through the expanded bile duct, so that patients successfully could avoid a second liver transplantation.

  

 The patient’s mother excitedly said, "When the jaundice of the child increased, I first thought of Shanghai Renji Hospital. I know it’s the world's best hospital of child liver transplantation. I believe it. Through this treatment my child could avoid a second liver transplantation. After just two days, the child's eyes have turned white, and his face is not yellow. The child is no longer anxiety because of itching, and she can rest quietly! Thank you doctors of Renji!

   

 As the largest child liver transplantation center in China, Department of Liver Surgery at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine has completed the most number of liver transplant surgeries in children in the past six years after more than 10 years of rapid development. The postoperative 1-year and 5-year survival rates were 93.1% and 80.0%, respectively, which have reached the international advanced level. Currently the center has completed nearly 900 cases of liver transplantation in children. This is also another case of foreign child who seek Professor Qiang Xia for proficient treatment, after the last time when Renji Hospital accepted Malaysian children for the implementation of living donor liver transplantations in recent years. (Correspondent Huiyun Yuan / Translator Weiwei Zhang)