Related Experiment Video
Updated: Aug 2, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Biliary complications and their management in pediatric liver transplantations: one center's experience
H Karakayali1, F Boyvat, S Sevmiş
1Başkent University Faculty of Medicine, Department of General Surgery, Ankara, Turkey.
Insights
Biliary complications after pediatric liver transplants are common. Interventional radiology effectively treated leaks without surgery, preventing sepsis and ensuring long-term patency.
Area of Science:
- Hepatology
- Pediatric Surgery
- Interventional Radiology
Background:
- Biliary complications occur in 15-30% of pediatric liver transplant recipients.
- These complications are a significant cause of morbidity in this population.
Purpose of the Study:
- To retrospectively analyze the incidence and management of biliary complications in pediatric liver transplant patients.
- To evaluate the effectiveness of interventional radiologic approaches in treating these complications.
Main Methods:
- Retrospective analysis of 21 pediatric liver transplant patients (ages 1-18) between 2001 and 2004.
- Review of biliary reconstruction methods (duct-to-duct anastomosis vs. Roux-en-Y hepaticojejunostomy) and postoperative complications.
- Assessment of interventional radiology outcomes for biliary leaks.
Main Results:
- Six patients (28.5%) experienced postoperative biliary complications, primarily biliary leaks.
- Four leaks occurred with duct-to-duct anastomosis, two with hepaticojejunostomy.
- All biliary leaks were successfully treated non-surgically using interventional radiology, with five cases of leakage treated successfully.
- One patient with a duct-to-duct anastomosis leak developed stenosis after healing.
Conclusions:
- Interventional radiologic approaches are effective for managing biliary complications in pediatric liver transplant recipients, even with disrupted anastomoses.
- Percutaneous drainage combined with internal drainage can prevent biliary sepsis and promote long-term patency.
Abstract:
Following living-donor liver transplantation, biliary complications are more prevalent among pediatric patients (<18 years old), with reported rates varying between 15% and 30%. In this study, we retrospectively analyzed biliary complications observed in 21 pediatric liver transplant patients (16 boys [76.2%], 5 girls [23.8%] of ages 1 to 18 years (mean, 8.3 +/- 5.05 years) between September 2001 and June 2004. Biliary reconstruction was accomplished via a duct-to-duct anastomosis in 12 (57.1%) and a Roux-en-Y hepaticojejunostomy in 9 (42.9%) patients. Postoperative biliary complications were encountered in six (28.5%) patients. Four of the biliary leaks were from a duct-to-duct anastomosis and two from an hepaticojejunostomy. One (4.7%) patient who experienced biliary leakage after a duct-to-duct anastomosis developed stenosis after the leak healed; five (23.8%) had the leakage treated successfully. One patient had biliary leakage from the duct-to-duct anastomosis subsequent to a hepatic artery thrombosis. All patients with biliary leakage were treated without surgery. Mean follow-up time was 10.2 +/- 9.6 months (range, 1 to 26 months). Three patients died during follow-up; however, these deaths were not related to the biliary complications. Interventional radiologic approaches are effective to biliary complications, even when the anastomoses are heavily disrupted. In cases of biliary complication, percutaneous combined with internal drainage may prevent biliary sepsis and provide long-term patency.
