Management of the bile duct anastomosis and its complications after liver transplantation

Endoscopic approach for management of biliary strictures in liver transplant recipients: A systematic review and meta‐analysis

“…Treatment of post‐liver transplantation biliary strictures has diversified during the last few years, from surgical to endoscopic repair, 1 with success rates of about 60% and 80% for living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT), respectively 2 . Among the minimally invasive procedures, dilation of the strictures and biliary stent insertion by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) are emphasized.…”

Biliary complications after adult to adult right-lobe living donor liver transplantation (A-ARLLDLT): Analysis of 245 cases during 16 years period at a single high centre- A retrospective cohort study

“…Bile leaks occur mostly during the 1st two months post LDLT and their rate may reach up to 37% of recipients [ 3 , 9 , 21 ], moreover, they may come from the anastomotic site, the cut surface of the liver graft [ [22] , [23] , [24] ], or the cystic duct stump [ 22 , 25 ] and can be managed conservatively [ 26 ] and/or by Percutaneous drainage [ 23 , 25 , 26 ], and/or by ERCP ± sphinectrotoy ± stenting [ 5 , 22 , 23 , [25] , [26] , [27] ] and/or by re-operation [ 5 , 22 , [25] , [26] , [27] ]. Similarly, biliary leaks that affected 27.3% of our patients occurred during the 1st two post-transplant months (median 0.5 (range, (0.03–2) months) from the anastomotic site (51/67; 76%), the graft cut surface(16/67; 24%), and the cystic duct stump(1/67; 1.5%), and were treated conservatively(25/67; 37%), by percutaneous drainage(54/67; 81%), by ERCP ± Stenting (26/67; 39%) and/or by surgery(surgical drainage, external biliary diversion and HJ)(9/67; 13%) with favourable outcomes in 51/67(76%) of them.…”

“…They are anastomotic-/non-anastomotic ones; moreover, they may be angulated, tortuous, twisted, fork-shaped, trident-shaped, multi-branched, long and/or complicated strictures leading to more challenging therapy [ [28] , [29] , [30] ]. However, they can be managed successfully by endoscopy(ERCP ± sphinectrotomy ± ballon dilatation ± stenting) [ 5 , 7 , 9 , [11] , [12] , [13] , 21 , 23 , 27 , [30] , [31] , [32] , [33] , [34] ], by PTBD [ 2 , 7 , 9 , [11] , [12] , [13] , 21 , 23 , [31] , [32] , [33] ] and/or by surgery (HJ) [ 7 , 12 , 21 , 32 , 33 ]. In the same way; the post LT biliary strictures (early and/or late) that affected 54(22%) of our recipients at a median of 5 (range, 2–36) months were managed by ERCP ± Stent(52/54; 96.3%), by PTBD (2/54; 3.7%), and/or by surgery(HJ)(16/54; 29.6%) with favourable outcome in 46/54(85.2%) of them.…”