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Internal biliary stenting in liver transplantation

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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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Authors and Affiliations

  1. Service de Chirurgie Digestive et Générale, Hôpital Michallon, Centre Hospitalier Universitaire Grenoble-Alpes, Boulevard de la Chantourne, 38700, La Tronche, France

    Edouard Girard, Olivier Risse, Julio Abba, Mircea Chirica & Christian Letoublon

  2. Laboratory TIMC, CNRS, Grenoble-Alpes University, Grenoble, France

    Edouard Girard & Maud Medici

  3. Clinical Investigation Center for Innovative Technologies, Grenoble-Alpes University, Grenoble, France

    Maud Medici

  4. Department of Gastroenterology, Grenoble-Alpes University, Grenoble, France

    Vincent Leroy

Authors
  1. Edouard Girard
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  2. Olivier Risse
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  4. Maud Medici
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  5. Vincent Leroy
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  6. Mircea Chirica
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Contributions

Seven authors make substantial contributions to the development of this manuscript. Girard, O. Risse, V. Leroy, and C. Letoublon design the study; E. Girard, O. Risse, and J. Abba performed acquisition of data; M. Medici and M. Chirica made data analysis. E. Girard and M. Chirica wrote the paper; O. Risse, J. Abba, M. Medici, V. Leroy, and C. Letoublon reviewed the paper.

Corresponding author

Correspondence to Edouard Girard.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Girard, E., Risse, O., Abba, J. et al. Internal biliary stenting in liver transplantation. Langenbecks Arch Surg 403, 487–494 (2018). https://doi.org/10.1007/s00423-018-1669-y

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