Endoscopic treatment of biliary complications after right-lobe living-donor liver transplantation with duct-to-duct biliary anastomosis.
OBJECTIVE
The aims of this study were to characterize the features of the biliary complications that occur after right-lobe living-donor liver transplantation (RL-LDLT) with duct-to-duct biliary anastomosis, and to evaluate the efficacy of treating biliary complications endoscopically.


METHODS
The records of 273 consecutive patients who underwent RL-LDLT with duct-to-duct biliary anastomosis from July 1999 through July 2005 at Kyoto University Hospital were reviewed to determine the overall incidence of postoperative biliary complications and the outcome of endoscopic repair of those complications.


RESULTS
Biliary complications occurred in 93 (34.1%) of the patients. These complications were: 80 biliary strictures (75 anastomotic and 5 nonanastomotic) and 16 biliary leakages (5 patients with biliary leakage also had a biliary stricture); most (72%) of the anastomotic strictures were complex (i.e., fork-shaped or trident-shaped). The strictures and leakages were repaired by the endoscopic placement of multiple inside stents above the sphincter of Oddi, and by nasobiliary drainage, respectively. The procedure was successful in repairing 51 (68.0%) of the anastomotic strictures and 8 (50.0%) of the biliary leakages.


CONCLUSIONS
Endoscopic stenting of the bile ducts is efficacious in treating biliary complications related to RL-LDLT with duct-to-duct biliary anastomosis and the stenting should be attempted before surgical revision of strictures and leakages.
Yazumi
Shujiro
S
Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Shogoinkawara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Yoshimoto
Takanobu
T
Hisatsune
Hiroshi
H
Hasegawa
Kazunori
K
Kida
Masaya
M
Tada
Shinsuke
S
Uenoyama
Yoshito
Y
Yamauchi
Junichi
J
Shio
Seiji
S
Kasahara
Mureo
M
Ogawa
Kohei
K
Egawa
Hiroto
H
Tanaka
Koichi
K
Chiba
Tsutomu
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000601:surgery*; D001660:Biliary Tract Diseases / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome