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Internal biliary stenting in orthotopic liver transplantation.
Liver Transpl. 2000 May; 6(3):356-61.LT

Abstract

Biliary complications account for significant morbidity in orthotopic liver transplantation (OLT), with a reported incidence ranging from 6% to 47%, and 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 choledochocholedochostomy over an internal stent. Three patients died within 1 week post-OLT, leaving 74 patients for evaluation (follow-up, 2 to 38 months). Stents were placed transanastomotic and transsphincteric at the time of OLT and secured with a dissolvable suture. At 4 to 6 weeks post-OLT, stents visible within the biliary tree on kidney, ureters, and bladder radiograph were removed endoscopically. Graft and patient survival rates were 92% and 96%, respectively. There were 12 biliary complications (18%): anastomotic leak in 6 patients (9%), anastomotic stricture in 5 patients (7.6%), and stent migration in 1 patient (1.5%). Thirty-two patients (43%) passed the biliary stent without intervention, whereas 42 patients (57%) underwent esophagogastro duodenoscopy (EGD) stent removal at 4 to 6 weeks without incident. Treatment of the complications included percutaneous drainage, endoscopic dilatation with stenting, and/or conversion to Roux-en-Y choledochojejunostomy. The use of the 6 F Silastic, double-J, ureteral stent provides a safe and effective means of stenting the biliary anastomosis in OLT. Major advantages to this method are that it: (1) is completely internal, (2) is biliary decompressive, (3) is radiopaque, (4) can be spontaneously passed, and (5) is easily accessible for EGD extraction.

Authors+Show Affiliations

Department of Surgery, Section of Transplantation, University of North Carolina, Chapel Hill 27599-7210, USA. mark_johnson@med.unc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10827239

Citation

Johnson, M W., et al. "Internal Biliary Stenting in Orthotopic Liver Transplantation." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 6, no. 3, 2000, pp. 356-61.
Johnson MW, Thompson P, Meehan A, et al. Internal biliary stenting in orthotopic liver transplantation. Liver Transpl. 2000;6(3):356-61.
Johnson, M. W., Thompson, P., Meehan, A., Odell, P., Salm, M. J., Gerber, D. A., Zacks, S. L., Fried, M. W., Shrestha, R., & Fair, J. H. (2000). Internal biliary stenting in orthotopic liver transplantation. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 6(3), 356-61.
Johnson MW, et al. Internal Biliary Stenting in Orthotopic Liver Transplantation. Liver Transpl. 2000;6(3):356-61. PubMed PMID: 10827239.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Internal biliary stenting in orthotopic liver transplantation. AU - Johnson,M W, AU - Thompson,P, AU - Meehan,A, AU - Odell,P, AU - Salm,M J, AU - Gerber,D A, AU - Zacks,S L, AU - Fried,M W, AU - Shrestha,R, AU - Fair,J H, PY - 2000/5/29/pubmed PY - 2000/6/17/medline PY - 2000/5/29/entrez SP - 356 EP - 61 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl VL - 6 IS - 3 N2 - Biliary complications account for significant morbidity in orthotopic liver transplantation (OLT), with a reported incidence ranging from 6% to 47%, and 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 choledochocholedochostomy over an internal stent. Three patients died within 1 week post-OLT, leaving 74 patients for evaluation (follow-up, 2 to 38 months). Stents were placed transanastomotic and transsphincteric at the time of OLT and secured with a dissolvable suture. At 4 to 6 weeks post-OLT, stents visible within the biliary tree on kidney, ureters, and bladder radiograph were removed endoscopically. Graft and patient survival rates were 92% and 96%, respectively. There were 12 biliary complications (18%): anastomotic leak in 6 patients (9%), anastomotic stricture in 5 patients (7.6%), and stent migration in 1 patient (1.5%). Thirty-two patients (43%) passed the biliary stent without intervention, whereas 42 patients (57%) underwent esophagogastro duodenoscopy (EGD) stent removal at 4 to 6 weeks without incident. Treatment of the complications included percutaneous drainage, endoscopic dilatation with stenting, and/or conversion to Roux-en-Y choledochojejunostomy. The use of the 6 F Silastic, double-J, ureteral stent provides a safe and effective means of stenting the biliary anastomosis in OLT. Major advantages to this method are that it: (1) is completely internal, (2) is biliary decompressive, (3) is radiopaque, (4) can be spontaneously passed, and (5) is easily accessible for EGD extraction. SN - 1527-6465 UR - https://www.unboundmedicine.com/medline/citation/10827239/Internal_biliary_stenting_in_orthotopic_liver_transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1527646500083477 DB - PRIME DP - Unbound Medicine ER -