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Mohanka R, Rao P, Golhar A, Nikam V, Shrimal A, Shah M, Shukla A, Pargewar S, Bhade R, Gadre P, Dholu R. Archimedes Absorbable Internal Biliary Stent in Liver Transplants to Prevent Bile Leak. Transplant Proc 2021; 53:2923-2928. [PMID: 34756648 DOI: 10.1016/j.transproceed.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/02/2021] [Accepted: 09/24/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Biliary complications, especially bile leaks, are an important cause of early postoperative morbidity and, rarely, mortality after liver transplant. The risk is higher in living donor liver transplant (LDLT) compared to deceased donor liver transplant (DDLT). Attempts to reduce bile leaks have included refinements in the biliary anastomosis technique and use of various external and internal stents, with inconsistent benefits. Recent availability and successful use of the absorbable Archimedes stent has prompted its intrabiliary placement across the anastomosis. METHODS In this retrospective study, we analyzed the data of 20 adult patients who underwent a liver transplant with duct-to-duct biliary anastomosis using the Archimedes stent. Both DDLT and LDLT were performed using cava-preserving hepatectomy followed by standard implantation methods. Duct-to-duct biliary anastomosis was performed in all cases using interrupted sutures with extracorporeal knots over an absorbable intrabiliary stent. In addition to standard postoperative care, patients were monitored for bile leak. RESULTS Nine DDLTs had a single anastomosis over a 10-Fr stent. Out of 11 LDLT patients, 7 had a single anastomosis and 4 patients had 2 anastomoses, all over a 6-Fr stent. Two patients died, 1 as a result of graft primary nonfunction and another because of multidrug-resistant pneumonia. One patient had ascending cholangitis owing to stent migration in the duodenum. This episode was treated with endoscopic stent removal and appropriate antibiotics, with good recovery. None of the other patients had bile leaks, biloma, or stent-related complications. CONCLUSIONS Archimedes internal absorbable biliary stents can be safely used in both living and deceased donor liver transplants to prevent bile leaks.
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Affiliation(s)
- Ravi Mohanka
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India.
| | - Prashantha Rao
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India
| | - Ankush Golhar
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India
| | - Vinayak Nikam
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India
| | - Anurag Shrimal
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India
| | - Mitul Shah
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India
| | - Akash Shukla
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India
| | - Sudheer Pargewar
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India
| | - Rashmi Bhade
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India
| | - Parul Gadre
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India
| | - Ritesh Dholu
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, Mumbai, Maharashtra, India
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Koc C, Akbulut S, Bilgic Y, Otan E, Sarici B, Isik B, Bayindir Y, Kutlu R, Jeng LB, Yilmaz S. Artificial vascular graft migration into hollow viscus organs in patients who underwent right lobe living donor liver transplantation. Acta Chir Belg 2020; 120:404-412. [PMID: 32496869 DOI: 10.1080/00015458.2020.1778266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To share our experience with hollow viscus migration of artificial vascular grafts (AVG) used for venous reconstruction of the right anterior sector in living donor liver transplantations (LDLT). METHODS Clinical, radiological, and endoscopic data of 13 right lobe LDLT patients (range: 26-67 years) with a diagnosis of postoperative AVG migration into adjacent hollow viscus were analyzed. RESULTS Biliary complications were detected in 12 patients. A median of four times endoscopic retrograde cholangiopancreatography (ERCP) procedures were performed in 11 patients prior to AVG migration diagnosis. A median of 2.5 times various percutaneous radiological interventional procedures were performed in eight patients prior to AVG migration diagnosis. The site of migration was the duodenum in eight patients, gastric antrum in four, and Roux limb in the remaining one patient. The migrated AVS were made of polytetrafluoroethylene (PTFE) in 10 patients and polyethylene terephthalate (Dacron) in three. The migrated AVGs were endoscopically removed in seven patients and surgically removed in six. Only one patient died due to sepsis unrelated to AVG migration. CONCLUSION AVG migration into the adjacent hollow viscus following right lobe LDLT is a rare and serious complication. Repetitive ERCP, interventional radiological procedures, infection related to biliary leakage, and thrombosis of AVGs are among the possible risk factors.
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Affiliation(s)
- Cemalettin Koc
- Liver Transplant Institute, Inonu University, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Inonu University, Malatya, Turkey
| | - Yilmaz Bilgic
- Department of Gastroenterology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Emrah Otan
- Liver Transplant Institute, Inonu University, Malatya, Turkey
| | - Baris Sarici
- Liver Transplant Institute, Inonu University, Malatya, Turkey
| | - Burak Isik
- Liver Transplant Institute, Inonu University, Malatya, Turkey
| | - Yasar Bayindir
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Long-Bin Jeng
- Department of Surgery and Organ Transplant Center, China Medical University Hospital, Taichung, Taiwan
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University, Malatya, Turkey
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The high-end range of biliary reconstruction in living donor liver transplant. Curr Opin Organ Transplant 2020; 24:623-630. [PMID: 31397730 DOI: 10.1097/mot.0000000000000693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To summarize recent evidence in literature regarding incidence and risk factors for biliary complications in living donor liver transplantation (LDLT), and current concepts in evaluation of donor biliary anatomy and surgical techniques of biliary reconstruction, to reduce the incidence of biliary complications. RECENT FINDINGS Advances in biliary imaging in the donor, both before surgery, and during donor hepatectomy, as well as safe hepatic duct isolation in the donor, have played a significant role in reducing biliary complications in both the donor and recipient. Duct-to-duct biliary anastomoses (DDA) is the preferred mode of biliary reconstruction currently, especially when there is a single bile duct orifice in the donor. The debate on stenting the anastomoses, especially a DDA, continues. Stenting a Roux en Y hepaticojejunostomy in children with small ductal orifices in the donor is preferred. With growing experience, and use of meticulous surgical technique and necessary modifications, the incidence of biliary complications in multiple donor bile ducts, and more than one biliary anastomoses can be reduced. SUMMARY Biliary anastomosis continues to be the Achilles heel of LDLT. Apart from surgical technique, which includes correct choice of type of reconstruction technique and appropriate use of stents across ductal anastomoses, better imaging of the biliary tree, and safe isolation of the graft hepatic duct, could help reduce biliary complications in the recipient, and make donor hepatectomy safe .
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Naseer F, Lin CH, Lin TS, Kuo PJ, Chia-Shen Yang J, Chiang YC. Long-term Results in Comparative Analysis of Merits in Using Polypropylene and Polydioxanone for Microsurgical Biliary Reconstruction in Living Donor Liver Transplantation. Transplant Proc 2020; 52:233-238. [DOI: 10.1016/j.transproceed.2019.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/11/2019] [Accepted: 11/02/2019] [Indexed: 01/05/2023]
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