Is the use of transanastomotic internal stent in adult living donor liver transplantation a reliable option to reduce postoperative biliary complications? Comparison of our results with the literature

OBJECTIVE: The aim of this study is to evaluate the effect of transanastomotic internal stent use on postoperative biliary complications in adult living-donor liver transplant patients and to compare the results with literature data. METHODS: This retrospective study included a total of 64 patients who underwent adult living-donor liver transplantation at our center between May 2023 and November 2025. Excluding 6 patients who experienced early mortality and were excluded from evaluation for biliary complications, biliary complication analysis was performed on 58 patients. All patients underwent transanastomotic internal stent placement during biliary reconstruction. Biliary complications were classified as early and late. Biliary leaks were defined as bilioma. Demographic data, preoperative clinical characteristics, intraoperative parameters, and postoperative outcomes were recorded. Patients with and without biliary complications were compared. Statistical analyses were performed using SPSS software, and a p-value < 0.05 was considered the statistical significance level. RESULTS: The overall biliary complication rate was found to be 15.5% in the 58 patients included in the study. The early biliary complication rate was 5.2%, and the late biliary complication rate was 12.1%. All early biliary complications were in the form of bilioma and were successfully controlled with percutaneous drainage catheterization. In the late period, biliary stricture developed in 6 patients, and bilioma due to a biliary fistula developed in 1 patient. In all patients with biliary stricture, the complications were controlled by internal stent placement via percutaneous thoracic catheterization (PTC) or ERCP. Late mortality occurred in one patient due to persistent biliary fistula-bilioma and resulting biliary sepsis despite repeated interventions. All 6 patients who experienced early mortality died from causes unrelated to biliary complications. The mortality rate due to biliary complications was determined to be 1.7%. When comparing patients with and without biliary complications, intraoperative erythrocyte suspension replacement (p=0.027) and postoperative hospital stay (p=0.036) were found to be significantly associated with the development of biliary complications. CONCLUSION: The use of transanastomotic internal stents in adult living-donor liver transplantation contributes to low rates of biliary complications and allows for the control of most complications through interventional methods. Provided that appropriate patient selection is made and the procedure is performed in experienced centers, this approach can be considered a reliable and effective surgical strategy that contributes to reducing biliary complications. KEYWORDS: Living donor liver transplantation, biliary complications, transanastomotic internal stent, bilioma, biliary stricture.