Archimedes® Absorbable Internal Biliary Stent in Liver Transplants to Prevent Bile Leak

Abstract

Introduction: Biliary complications, especially bile leaks are an important cause of early post-operative morbidity and rarely mortality after liver transplant. The risk is higher in living donor liver transplant (LDLT) compared to deceased donor liver transplant (DDLT) because of many well-known factors. Attempts to reduce bile leaks have included improvements in graft retrieval, refinements in the biliary anastomosis technique and use of various external and internal stents with inconsistent benefits. Recent availability and successful use of the absorbable Archimedes® stent has prompted its intra-biliary placement across the anastomosis. Methods: In this retrospective study, we analyzed data of 20 adult patients who underwent liver transplantion from December 2019 to January 2020 with duct-to-duct biliary anastomosis (DDA) using Archimedes® stent.. Liver Transplantion was performed using cava-preserving hepatectomy followed by standard implantation methods. Duct-to-duct (DDA) biliary anastomosis was performed using interrupted polydioxanone sutures with extracorporeal knots over an absorbable intra-biliary stent. Results: Nine DDLT had a single anastomosis over a 10Fr stent. Out of 11 LDLT patients, 7 had a single anastomosis and 4 patients had two anastomosis, all over a 6Fr stent. Two patients died due to graft primary non-function and multi-drug resistant pneumonia respectively. One patient had ascending cholangitis due to stent migration and was managed with endoscopic stent removal and appropriate antibiotics. None of the other patients had bile leak, bilioma, stent related complications or required any endoscopic or radiological procedure. Conclusions: Archimedes® internal absorbable biliary stents can be safely used in both LDLT and DDLT to prevent bile leaks.