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Langenbeck's Archives of Surgery

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01-06-2018 | ORIGINAL ARTICLE

Internal biliary stenting in liver transplantation

Authors: Edouard Girard, Olivier Risse, Julio Abba, Maud Medici, Vincent Leroy, Mircea Chirica, Christian Letoublon

Published in: Langenbeck's Archives of Surgery | Issue 4/2018

Abstract

Purpose

Internal biliary stenting (IBS) was reported to decrease biliary complications after liver transplantation (LT) but data in literature is scarce. The aim of the present study was to evaluate our experience with end-to-end choledoco-choledocostomy during liver transplantation with special focus on the influence of IBS on patient and biliary outcomes.

Methods

Between 2009 and 2013, 175 patients underwent deceased donor LT with end-to-end choledoco-choledocostomy and were included in the study. Supra-papillary silastic stent was inserted in 67 patients (38%) with small-size (< 5 mm) bile ducts (recipient or donor). Endoscopic retrograde cholangiopancreatography (ERCP) was scheduled for IBS removal, 6 months after LT. Operative outcomes and survival of patients who received internal stenting (IBS group) were compared with those of patients who did not (no-IBS group). Risk factors for biliary anastomotic complications were identified.

Results

Ten patients died (6%) and 104 (59%) experienced postoperative complications. Five-year patient and graft survival rates were 77 and 74%, respectively. Biliary complications were recorded in 61 patients (35%) and were significantly decreased by IBS insertion (p = 0.0003). Anastomotic fistulas occurred in 23 patients (13%) and stenoses in 44 patients (25%). On multivariate analysis, high preoperative MELD scores (p = 0.02) and hepatic artery thrombosis (p < 0.0001) were predictors of fistula; absence of IBS was associated with both fistula (p = 0.014) and stricture (p = 0.003) formation.

Conclusions

IBS insertion during LT decreases anastomotic complication.

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Title: Internal biliary stenting in liver transplantation
Authors: Edouard Girard
Olivier Risse
Julio Abba
Maud Medici
Vincent Leroy
Mircea Chirica
Christian Letoublon
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 4/2018
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-018-1669-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Internal biliary stenting in liver transplantation

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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