Internal biliary stenting in orthotopic liver transplantation

Mark W. Johnson, Patricia Thompson, Ann Meehan, Pat Odell, M. Jane Salm, David A. Gerber, Steven L. Zacks, Michael W. Fried, Roshan Shrestha, Jeffrey H. Fair

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Biliary complications account for significant morbidity in orthotopic liver transplantation (OLT), with a reported incidence ranging from 6% to 47%, and many centers are reassessing the need and options available for stenting the biliary anastomosis. We report on our experience using a 6F Silastic, double-J, ureteral stent as an internal biliary stent in OLT. From October 15, 1995, to September 30, 1998, a total of 99 patients at our institution underwent 108 OLTs. Of these, 77 patients received an end-to-end choledochocholedochostomy over an internal stent. Three patients died within 1 week post-OLT, leaving 74 patients for evaluation (follow-up, 2 to 38 months). Stents were placed transanastomotic and transsphincteric at the time of OLT and secured with a dissolvable suture. At 4 to 6 weeks post-OLT, stents visible within the biliary tree on kidney, ureters, and bladder radiograph were removed endoscopically. Graft and patient survival rates were 92% and 96%, respectively. There were 12 biliary complications (18%): anastomotic leak in 6 patients (9%), anastomotic stricture in 5 patients (7.6%), and stent migration in 1 patient (1.5%). Thirty-two patients (43%) passed the biliary stent without intervention, whereas 42 patients (57%) underwent esophagogastro duodenoscopy (EGD) stent removal at 4 to 6 weeks without incident. Treatment of the complications included percutaneous drainage, endoscopic dilatation with stenting, and/or conversion to Roux-en-Y choledochojejunostomy. The use of the 6 F Silastic, double-J, ureteral stent provides a safe and effective means of stenting the biliary anastomosis in OLT. Major advantages to this method are that it: (1) is completely internal, (2) is biliary decompressive, (3) is radiopaque, (4) can be spontaneously passed, and (5) is easily accessible for EGD extraction.

Original languageEnglish (US)
Pages (from-to)356-361
Number of pages6
JournalLiver Transplantation
Volume6
Issue number3
DOIs
StatePublished - May 2000

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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    Johnson, M. W., Thompson, P., Meehan, A., Odell, P., Salm, M. J., Gerber, D. A., Zacks, S. L., Fried, M. W., Shrestha, R., & Fair, J. H. (2000). Internal biliary stenting in orthotopic liver transplantation. Liver Transplantation, 6(3), 356-361. https://doi.org/10.1053/lv.2000.5303