Simultaneous surgical and interventional radiological approach to treat complicated biliary strictures after pediatric liver transplantation

Pediatric Transplantation
Paolo R O SalvalaggioRiccardo A Superina

Abstract

Post-transplantation biliary strictures occur in 5-15% of the pediatric liver transplant patients and are conventionally managed by interventional radiological techniques. Failure of this treatment leads to reoperation and sometimes to retransplantation. Herein, we describe a surgical approach and interventional radiologic approach to manage biliary strictures that failed the conventional radiologic treatment, in order to avoid retransplantation. Included in the study were eight children who underwent liver transplantation at our center or referred to our institution for evaluation of the biliary strictures that failed radiological treatment. Biliary strictures were confirmed by a narrowing of the biliary anastomosis on the percutaneous transhepatic cholangiogram. At surgery, a guide wire was introduced into the distal bile system through the use of an enterotomy in Roux limb. Over the guide wire, the stricture was ballooned and the diameter of the biliary tree was determined. A pigtail catheter was introduced on the biliary tree across the abdominal wall, the liver, the stricture and the anastomosis into the enterotomy. A final cholangiogram confirmed the positioning of the catheter. Mean follow-up was 39.8 +/- 20.8 months. Al...Continue Reading

References

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Citations

Feb 4, 2010·Gastroenterología y hepatología·Paloma Jara, Loreto Hierro
Apr 22, 2006·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Baburao KoneruPhillip F Bahramipour
Apr 22, 2006·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Bhanu SunkuEstella M Alonso
Aug 2, 2007·Journal of Pediatric Gastroenterology and Nutrition·Chieh-Chung LinPeter F Whitington

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