Diagnostic and therapeutic management algorithm for biliary

Abstract

This study aimed to demonstrate the efficacy of our diagnostic and therapeutic management algorithm and catheter-assisted (percutaneous transhepatic biliary tract drainage [PTBD] or transanastomotic feeding tube) hepaticojejunostomy (HJ) procedures in living liver donors (LLDs) with biliary complications. Living donor hepatectomy (LDH) was performed between September 2005 and April 2021 in 2 489 LLDs. Biliary complications developed in 220 LLDs (8.8%), 136 of which were male, and the median age was 29 (interquartile range [IQR]: 12) years. Endoscopic sphincterotomy +/- stenting was performed in 132 LLDs, which was unsuccessful in 9 LLDs and required HJ. Overall, 142 LLDs underwent interventional radiologic procedures. Fifteen LLDs with biliary complications underwent HJ (PTBD catheter = 6 and transanastomotic feeding tube = 9) at a median of 44 days (IQR: 82). Following HJ, 14 LLDs did not have any complications throughout the median follow-up period of 1619 days (IQR: 1454). However, percutaneous dilation for HJ anastomotic stricture was performed in one patient. Biliary complications are very common following LDH; therefore, surgeons in the field should have a low threshold to perform HJ for biliary complications that persist after other treatments. Our catheter-assisted HJ techniques demonstrated a high success rate and aided HJ in a hostile abdomen during revisional surgery.

C1 [Yilmaz, Sezai; Akbulut, Sami; Usta, Sertac; Ozsay, Oguzhan; Sahin, Tevfik Tolga; Sarici, Kemal Baris; Karabulut, Ertugrul; Baskiran, Adil; Gonultas, Fatih; Ozdemir, Fatih; Ersan, Veysel; Isik, Burak; Dirican, Abuzer] Inonu Univ, Fac Med, Liver Transplant Inst, Elazig Yolu 10 Km, TR-44280 Malatya, Turkey.

[Kutlu, Ramazan] Inonu Univ, Fac Med, Dept Radiol, Malatya, Turkey.

[Harputluoglu, Murat] Inonu Univ, Fac Med, Dept Gastroenterol & Hepatol, Malatya, Turkey.