To stent or not to stent: the use of transanastomotic biliary stents in liver transplantation and patient outcomes.

BACKGROUND: There is no substantial evidence for the use of biliary stents in bile duct reconstruction during liver transplantation. METHOD: A longitudinal, retrospective cohort study was performed to compare biliary complications between stented and non-stented patients between 2011 and 2015 at the Princess Alexandra Hospital, Brisbane, Australia. RESULTS: We found no significant difference in biliary complications between stented and non-stented groups. Stented patients were 3.31 times as likely to require subsequent intervention, mainly in the form of stent removal. CONCLUSION: These results suggest that there is limited benefit in the placement of endobiliary stents in liver transplantation. Given that this was purely an observational study, causality cannot be proven and a prospective cohort trial would be beneficial in further defining these relationships.

Magnetic Compression Duct-to-duct Anastomosis for Biliary Obstruction in a Patient with Living Donor Liver Transplantation.

Magnetic compression anastomosis (MCA) is a minimally invasive method of performing choledochocholedochostomy without surgery in patients with biliary stricture or obstruction. We describe a successful case involving magnetic compression duct-to-duct biliary reconstruction in right-lobe living donor liver transplantation (RL-LDLT). Endoscopically, a samarium-cobalt (Sm-Co) rare-earth magnet was placed at the superior site of obstruction via the percutaneous transhepatic biliary drainage route, and another Sm-Co magnet was also placed at the inferior site of obstruction with the aid of an endoscope. MCA techniques enabled complete anastomosis without procedure-related complications. In conclusion, the MCA technique is a revolutionary method of performing choledochocholedochostomy in patients with biliary obstruction after LDLT.

Magnetic Compression Duct-to-duct Anastomosis for Biliary Obstruction in a Patient with Living Donor Liver Transplantation

Magnetic compression anastomosis (MCA) is a minimally invasive method of performing choledochocholedochostomy without surgery in patients with biliary stricture or obstruction. We describe a successful case involving magnetic compression duct-to-duct biliary reconstruction in right-lobe living donor liver transplantation (RL-LDLT). Endoscopically, a samarium-cobalt (Sm-Co) rare-earth magnet was placed at the superior site of obstruction via the percutaneous transhepatic biliary drainage route, and another Sm-Co magnet was also placed at the inferior site of obstruction with the aid of an endoscope. MCA techniques enabled complete anastomosis without procedure-related complications. In conclusion, the MCA technique is a revolutionary method of performing choledochocholedochostomy in patients with biliary obstruction after LDLT.

Bile Duct Reconstruction without T-Tube at Liver Transplantation / 대한이식학회지

BACKGROUND/AIMS: Biliary complication after orthotopic liver transplantation(OLT) continue to be a significant cause of surgical morbidity, occurring in 10~50% of patients. Bile duct obstruction and biliary leaks account for the majority of these complications. An end-to-end choledochocholedochostomy(CD) with or without T-tube or a Roux-en-Y choledochojejunostomy(CDJ) have been the standard methods of biliary reconstruction following OLT. We reviewed our experiences of OLT to assess whether or not use of the T-tube leads to increased biliary tract complications. MATERIALS AND METHODS: From May 1996 to Feb 1998, 34 consecutive liver transplantation in 33 patients were performed at our hospital, including 12 living related liver transplantaiton. Nineteen patients were male and twenty-two patients were adult. The main indication of OLT was hepatitis B virus related cirrhosis(14 cases)in adult and biliary atresia(7 cases) in child. Four ABO incompatible cases were included in living related liver transplant. Biliary tract complications were categorized as bile leak, stenosis, or obstruction that required therapeutic intervention. Retrospective review of clinical recordings and laboratory findings were done. The median follow up periods was 10 months(range: 3~24 month). RESULTS: The methods of biliary reconstruction in cadaveric liver transplant were CD with T-tube(n=2), CD without T-tube(n=18) and Roux-en-Y HJ(n=2), respectively. In living related liver transplant(LRLT), all 12 cases were reconstructed by Roux-en-Y CDJ without stent. Biliary tract complications were observed in one case of child LRLT patient that biliary fistula occurred at exposed bile duct on cut surface of liver. This patient underwent reoperation for constructed another HJ and progressed without complication. T-tube related complication was observed in one adult patient. T-tube was impinged at cystic duct that obstructed bile flow, intermittently. This patient was treated with insertion of PTBD catheter and removal of T-tube. No other biliary complications were detected in our series. CONCLUSION: Performing an end-to-end CD without T-tube was a safe and effective method of reconstructing the biliary tract following hepatic transplantation in adult patients, comparing with T-tube splintage method. We concluded that routine placement of the T-tube at hepatic transplantation was considered to some selective cases, but more large scale and long -term studies were needed.

Bile Duct Reconstruction without T-Tube at Liver Transplantation / 대한이식학회지

BACKGROUND/AIMS: Biliary complication after orthotopic liver transplantation(OLT) continue to be a significant cause of surgical morbidity, occurring in 10~50% of patients. Bile duct obstruction and biliary leaks account for the majority of these complications. An end-to-end choledochocholedochostomy(CD) with or without T-tube or a Roux-en-Y choledochojejunostomy(CDJ) have been the standard methods of biliary reconstruction following OLT. We reviewed our experiences of OLT to assess whether or not use of the T-tube leads to increased biliary tract complications. MATERIALS AND METHODS: From May 1996 to Feb 1998, 34 consecutive liver transplantation in 33 patients were performed at our hospital, including 12 living related liver transplantaiton. Nineteen patients were male and twenty-two patients were adult. The main indication of OLT was hepatitis B virus related cirrhosis(14 cases)in adult and biliary atresia(7 cases) in child. Four ABO incompatible cases were included in living related liver transplant. Biliary tract complications were categorized as bile leak, stenosis, or obstruction that required therapeutic intervention. Retrospective review of clinical recordings and laboratory findings were done. The median follow up periods was 10 months(range: 3~24 month). RESULTS: The methods of biliary reconstruction in cadaveric liver transplant were CD with T-tube(n=2), CD without T-tube(n=18) and Roux-en-Y HJ(n=2), respectively. In living related liver transplant(LRLT), all 12 cases were reconstructed by Roux-en-Y CDJ without stent. Biliary tract complications were observed in one case of child LRLT patient that biliary fistula occurred at exposed bile duct on cut surface of liver. This patient underwent reoperation for constructed another HJ and progressed without complication. T-tube related complication was observed in one adult patient. T-tube was impinged at cystic duct that obstructed bile flow, intermittently. This patient was treated with insertion of PTBD catheter and removal of T-tube. No other biliary complications were detected in our series. CONCLUSION: Performing an end-to-end CD without T-tube was a safe and effective method of reconstructing the biliary tract following hepatic transplantation in adult patients, comparing with T-tube splintage method. We concluded that routine placement of the T-tube at hepatic transplantation was considered to some selective cases, but more large scale and long -term studies were needed.