Balkan Medical Journal
Original Articles

Optimal Endoscopic Management of Anastomotic Strictures After Double- Biliary Reconstruction in Right Lobe Living-Donor Liver Transplantation

1.

Department of Gastroenterology, İnönü University School of Medicine, Malatya, Turkey

2.

Department of Biostatistics and Medical Informatics, İnönü University School of Medicine, Malatya, Turkey

3.

Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey

Balkan Medical Journal 2021; 38: 348-356
DOI: 10.5152/balkanmedj.2021.21692
Read: 206 Downloads: 42 Published: 06 October 2021

Background: There is no consensus on the optimal drainage technique in the management of biliary anastomotic strictures occurring after right-lobe living-donor liver transplantation (RL LDLT).

Aims: To investigate whether there is a superiority between unilateral and bilateral drainage groups in terms of efficacy and safety of biliary drainage in RL LDLT patients undergoing double-biliary reconstruction.

Study Design: Retrospective Cohort

Methods: Between January 2009 and August 2019, 1693 patients underwent RL LDLT. Of these, 182 patients who developed biliary anastomotic strictures out of the 306 patients who had double-biliary  reconstruction, were included in the study. One hundred fifty-five patients with technical success were divided into 2 groups as unilateral (n=116) and bilateral (n=39) drainage groups. The groups were compared in terms of variable parameters such as clinical success, additional procedure, post-ERCP complication, procedures after clinical failure, hospital stay, mortality, and survival.

Results: The clinical success was higher in the bilateral group (70% vs. 82%, P = .201). In the initial and the follow-up periods, a total of 44 (38%) patients in the unilateral group were switched to the bilateral drainage group due to the increased need for stenting. The placement of a stent successfully solved the problem only in 28% (32/117) of the patients in the unilateral group, while this rate was 44% (17/39) in the bilateral group. The median follow-up time of both groups was 42 months, and was equal. The number of stent-free follow-up patients in the unilateral drainage group was less than that in the bilateral drainage group (4 and 7, respectively).

Conclusion: An active attempt should be made for bilateral drainage in patients with biliary anastomotic stricture following RL LDLT. However, for patients in whom bilateral drainage is not possible, unilateral drainage may be recommended, with the placement of a maximum number of stents following primary biliary balloon dilatation, depending on the degree of stricture.

Cite this article as: Çağın YF, Erdoğan MA, Sağlam O, et al. Optimal endoscopic management of anastomotic strictures after double-biliary reconstruction in right lobe living-donor liver transplantation.Balkan Med J.; 2021; 38(6):348-356.

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ISSN 2146-3123 EISSN 2146-3131