Internal biliary stenting in orthotopic liver transplantation

Biliary complications account for significant morbidity in orthotopic liver transplantation (OLT), with a reported incidence ranging from 6% to 47%, a nd many centers are reassessing the need and options available for stenting the biliary anastomosis, We report on our experience using a 6F Silastic, double-J, ureteral stent as an internal biliary stent in OLT. From October 15, 1995, to September 30, 1998, a total of 99 patients at our institution underwent 108 OLTs, Of these, 77 patients received an end-to-end choledocho choledochostomy over an internal stent. Three patients died within 1 week p ost-OLT, leaving 74 patients for evaluation (follow-up, 2 to 38 months). St ents were placed transanastomotic and transsphincteric at the time of OLT a nd secured with a dissolvable suture, At 4 to 6 weeks post-OLT, stents visi ble within the biliary tree on kidney, meters, and bladder radiograph were removed endoscopically. Graft and patient survival rates were 92% and 96%, respectively. There were 12 biliary complications (18%): anastomotic leak i n 6 patients (9%), anastomotic stricture in 5 patients (7.6%), and stent mi gration in 1 patient (1.5%), Thirty-two patients (43%) passed the biliary s tent without intervention, whereas 42 patients (57%) underwent esophagogast ro duodenoscopy (EGD) stent removal at 4 to 6 weeks without incident. Treat ment of the complications included percutaneous drainage, endoscopic dilata tion with stenting, and/or conversion to Roux-en-Y choledochojejunostomy. T he use of the 6F Silastic, double-J, ureteral stent provides a safe and eff ective means of stenting the biliary anastomosis in OLT. Major advantages t o this method are that it: (1) is completely internal, (2) is biliary decom pressive, (3) is radiopaque, (4) can be spontaneously passed, and (5) is ea sily accessible for EGD extraction.