Minimally invasive methods for the prevention and treatment of biliobiliary anastomotic strictures after orthotopic liver transplantation

Aim. To analyze the outcomes of minimally invasive management of biliobiliary anastomotic cicatricial strictures after orthotopic liver transplantation.

Materials and Methods. From 2018 to 2024, a total of 234 orthotopic liver transplants from deceased donors were performed. To prevent biliary complications, intraoperative indocyanine green fluorescence imaging was used. In all cases of anastomotic stricture, ultrasound of the graft and MR cholangiopancreatography were conducted, and cholestatic biochemical markers were evaluated. All patients (n = 25) underwent minimally invasive endoscopic or percutaneous antegrade treatment.

Results. The endoscopic method achieved a technical success rate of 84%, and the antegrade method of 100%. There were no deaths. A management algorithm for biliobiliary anastomotic strictures following liver transplantation was developed from the findings. Plastic stent placement led to complications in 37.5% of cases and nitinol stent placement in 5.9% (p = 0.006). The clinical success rate of plastic stents was 37.5%, while nitinol stents achieved 100% (p = 0.009). However, the recurrence rate of anastomotic strictures after removal of plastic versus nitinol stents did not differ significantly (p = 0.2).

Conclusion. The most justified approach to biliobiliary anastomotic cicatricial strictures after orthotopic liver transplantation is temporary placement of a covered nitinol stent for 3 months. If signs of stricture persist after stent removal, repeated stenting for another three months is indicated. Intraoperative assessment of perfusion using indocyanine green fluorescence is considered a promising method for preventing biliary complications, as it enables timely identification of ischemic zones and reduces the risk of their development.

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