Prevention and management of biliary anastomotic stricture in right-lobe living-donor liver transplantation

Biliary strictures can be categorized according to technical factor as anastomotic or nonanastomotic strictures. Biliary anastomotic stricture is a common complication after living-donor liver transplantation, occasionally causing deaths. The two most commonly used methods for biliary anastomosis are duct-to-duct anastomosis and hepaticojejunostomy. Before presenting a description of the latest techniques of duct-to-duct anastomosis and hepaticojejunostomy, this review first relates the technique of donor right hepatectomy, as most biliary complications suffered by recipients of living-donor liver transplantation originate from donor operations. Three possible causes of biliary anastomotic stricture, namely impaired blood supply, biliary anomaly, and technical flaw, are then discussed. Lastly, the review focuses on the latest management of biliary anastomotic stricture. Treatment modalities include endoscopic retrograde cholangiography with dilatation, percutaneous transhepatic biliary drainage with dilatation, conversion of duct-to-duct anastomosis to hepaticojejunostomy, and revision hepaticojejunostomy. End-to-side versus side-to-side hepaticojejunostomy is also discussed.