Short-term external biliary drainage in living donor liver transplantation using duct-to-duct anastomosis: a single-center experience.

Purpose: In living donor liver transplantation (LDLT), biliary complications (BC) represent the most frequent and challenging postoperative issues. Some centers have adopted external biliary drainage (EBD) to mitigate these complications. While the conventional practice typically involves maintaining the drainage tube for 3 to 12 months, our institution pioneered a short-term placement protocol lasting 6 weeks. This study presents a single-center experience showcasing the efficacy and outcomes of this short-term EBD in LDLT. Methods: Between January 2013 and November 2022, a total of 123 patients underwent liver transplantation at The Catholic University of Korea, Incheon St. Mary's Hospital. Of these, a retrospective cohort study was conducted on 59 patients who underwent duct-to-duct anastomosis with EBD, excluding 53 patients who underwent deceased donor liver transplantation and 11 patients with insufficient data (due to follow-up loss or absence of EBD). EBD (feeding tube, 500 mm, 5 French) was placed across the biliary anastomosis during the operation. EBD was naturally drained for the first 1 to 3 weeks and was removed after 6 weeks. Results: Overall, BC was observed in 22 patients (37.3%), comprising 4 cases (6.8%) of bile leakage and 18 cases (30.5%) of biliary stricture. Notably, without reoperation, all BC cases were successfully managed through minimally invasive interventions, including endoscopic retrograde biliary drainage and percutaneous transhepatic biliary drainage. Importantly, no mortalities were attributed to BC, nor were there any severe complications linked to the early removal of EBD. Conclusion: A single institutional experience showed the effectiveness and safety of short-term EBD.