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A New Percutaneous Biliary Path With a Biodegradable Stent for Intrahepatic Biliary Stenosis After Living Donor
Leonardo Montes1, Florencia Fernandez, Florencia Agostinelli
1From the Institute of Multiorgan Transplantation, Hepatobiliary Surgery and Hepatic Transplant Unit, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
Insights
Biodegradable stents offer a novel solution for pediatric liver transplant patients with biliary strictures. This minimally invasive approach successfully created a new biliary path, avoiding stent removal and long-term complications.
Area of Science:
- Hepatobiliary Surgery
- Pediatric Gastroenterology
- Biomaterials Science
Background:
- Biliary tract complications are a major cause of morbidity after living donor liver transplant (LDLT) in children.
- Management of intrahepatic biliary strictures can be challenging, often requiring complex reconstructive techniques.
Observation:
- A case report details an 8-month-old pediatric patient with biliary atresia who underwent LDLT and subsequently developed a refractory intrahepatic biliary stricture.
- Conventional internal drainage methods failed to resolve the stricture in the S2 segment.
Findings:
- A percutaneous biodegradable stent was successfully used to create a new biliary path via a novel connection between the intrahepatic duct and the intestinal loop.
- The biodegradable stent provided temporary support and degraded over time, eliminating the need for removal and minimizing complications.
- The patient remained asymptomatic with normal liver function tests and no restenosis at 18-month follow-up.
Implications:
- Biodegradable stents show promise as a safe and effective option for managing complex biliary complications in pediatric liver transplant recipients.
- This approach may represent a significant advancement in pediatric hepatobiliary surgery, though further research is needed to confirm long-term efficacy and standardize protocols.
Abstract:
Biliary tract complications are a significant source of morbidity following living donor liver transplant, especially in pediatric patients. These complications are influenced by graft type, bile duct anatomy, and reconstruction techniques. For a hepaticojejunostomy, percutaneous intervention is the first option preferred. Here, we present a case report of the successful use of a percutaneous biodegradable stent to manage an intrahepatic biliary stricture in an 8-month-old patient who had previously undergone living donor liver transplant for biliary atresia, thereby creating a new biliary path. The patient developed a dominant biliary stricture of segment S2 postoperatively, which was refractory to conventional internal drainage. We created a new biliary path via a novel connection between the intrahepatic duct and the intestinal loop with minimally invasive surgery. The biodegradable stent provided temporary structural support while gradually degrading, which eliminated the need for removal and minimized long-term complications. At 18 month follow-up, the patient remained asymptomatic with satisfactory liver function tests and no evidence of restenosis. This case illustrates the feasibility, safety, and potential benefits of biodegradable stents in pediatric liver transplant recipients. The findings suggest that biodegradable stents could represent a significant advancement in the management of complex biliary tract complications in children, although further studies are necessary to establish the long-term efficacy of this treatment and standardize the protocols.
