To Stent or Not to Stent: Is It a Question? Routine Trans-Cystic Stenting Does Not Reduce Biliary Anastomotic...

Area of Science:

• Hepatobiliary surgery
• Transplant surgery
• Gastroenterology

Background:

• Biliary anastomotic stricture (BAS) is a complication after orthotopic liver transplant (OLT).
• Transcystic externalised trans-anastomotic biliary stenting is a technique used in OLT.
• The effectiveness of this stenting technique in preventing BAS is unclear.

Purpose of the Study:

• To compare the incidence of biliary anastomotic stricture (BAS) in OLT patients with and without transcystic externalised trans-anastomotic biliary stenting.
• To identify risk factors associated with BAS development in OLT.

Main Methods:

• Retrospective analysis of a prospective database of 836 cadaveric OLT.
• Primary outcome measures: incidence of BAS and associated risk factors.
• Comparison of BAS rates between stented and non-stented patients, and between different biliary reconstruction types.

Main Results:

• Biliary anastomotic stricture (BAS) occurred in 32.8% of OLT patients.
• BAS was more frequent with duct-to-duct anastomosis (34.3%) compared to bilio-enteric reconstruction (18.7%).
• No significant difference in BAS prevalence between stented (34.5%) and non-stented (30.0%) patients.
• Independent risk factors for BAS included older donor age, earlier transplant period, higher MELD score, and duct-to-duct reconstruction.

Conclusions:

• Transcystic externalised biliary anastomotic stenting is not associated with a reduced incidence of biliary stricture in OLT.
• Duct-to-duct reconstruction is a significant risk factor for BAS.