Two-step biliary external stent removal after living donor liver transplantation

Biliary stenting plays an important role in living donor liver transplantation (LDLT) as the rate of biliary complication is higher in LDLT than in diseased donor whole LT. We use a 2-mm tube for stenting at the biliary anastomosis, externalize it through the lower common bile duct, and fistulize it using duodenal serosa. After 3 months without biliary complications ensured by a cholangiogram, the stent tube is removed in a two-step manner, allowing bile to drain under a fluoroscope. The incidence of local peritonitis was lower, and the hospital stay was shorter with the two-step procedure. We herein report on the method of the two-step removal and its efficacy.