The first successful recanalization of complete biliary anastomotic obstruction after right lobe LDLT with a magnetic compression anastomotic method

Abstract

Introduction: Biliary complications occur in up to 40% recipients after living donor liver transplantation (LDLT). Magnetic compression anastomotic (MCA) method is a lifesaving method for recanalization of duct-to-duct anastomosis strictures in the ineffectiveness of traditional minimal invasive methods. We would like to present the successful case of magnetic-compression recanalization of the anastomosis in patients with complete obstruction of the duct-to-duct anastomosis after LDLT. Method: Between December 2011 and February 2019, we have been performed 81 right lobe LDLTs with duct-to-duct anastomosis in our National Scientific Center of Surgery. 25 (30.8%) out of 81 recipients have had biliary complication and mortality cases are observed in 4(16%) out of 25 recipients. For correction of biliary complications, the endoscopic method was used in 12 (48%) cases, the percutaneous transhepatic method in 10 (40%), the open surgical method in 4 (16%) cases and the biliary stricture magnetic compression in 1 (4%) cases biliary anastomosis. The patient underwent transplantation of the right lobe of the liver from a living donor, after 1.5 years the stricture of the duct-to-duct anastomosis developed, then underwent endoscopic and percutaneous correction methods several times - without effect. Result: Magnetic compression anastomotic of cicatricial stricture of duct-to-duct anastomosis was performed. The length of the stricture was 6 mm, recanalization was achieved after 5 days. An endobiliary plastic stent was then installed. Side effects and complications were not observed. At the moment, the patient is under the supervision of a physician and systematically undergoes replacement of the endobiliary stent with a gradual increase in the size of the stent every 3 months. Conclusion: This technique is effective in certain cases, such as the ineffectiveness of endoscopic and percutaneous methods of correcting the anastomotic biliary stricture after liver transplantation.