Analysis of Adult to Adult Living Donor Liver Transplant Biliary Complications Using Non-Stented Biliary Anastomosis

Abstract

Abstract Background biliary tract reconstruction during liver transplantation (LT) is the final technical step and the cornerstone of the procedure and is often performed by a duct-to-duct anastomosis. Rarely, recipient and donor biliary stump discrepancies or liver disease-related reasons could lead to a hepaticojejunostomy. Purpose To clarify the role of non-stented biliary anastmosis in reducing biliary complications in adult to adult living donor liver transplant and ending the era of using intraductal removable stent. Patients and Methods this is a retrospective Single arm Cohort study. Our study was performed in Egypt by following the results of 80 cases of adult to adult living donor liver transplant using non-stented biliary anastomosis in Airforce specialized hospitals and Nasser institute in Cairo. Study period was from July 2015 to June 2018. Results The rate of biliary complications in non-stented patients was 23/80 (27%), and (27%) is subdivided as follow; (18%-strictures, 9%-leaks, and 1%-mixed), ) . All biliary complications had been treated with successful outcome representing 20/23(87%), while persistent biliary complication was in 3 (13%). Treatments used in biliary complications were (ERCP n = 22, PTC n = 5, Rendezvous n = 2, Surgical biliary-reconstruction n = 2). Conclusion Stentless biliary anastomosis is a well established and trusted method in biliary reconstruction in adult living donor liver transplant and has a less complications than stented duct to duct biliary anastomosis and biliary-enteric anastomosis and allow better management of biliary complication if occurred.