M. Chen1, S. Kapoor1, T. H. Baron2, C. S. Desai1 1University Of North Carolina At Chapel Hill, Department Of Surgery, Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill, Department Of Gastroenterology, Chapel Hill, NC, USA
Introduction:
Bariatric surgery can significantly ammeliorate obesity and its associated metabolic disorders. Nonetheless, some individuals will still experience progression of liver disease and eventual need for transplantation. Alteration of foregut anatomy, as is seen following Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD-DS), renders traditional access to the biliary tree impossible. This may complicate management of anastomotic biliary strictures (ABC) after liver transplantation.
Methods:
A single center retrospective review was performed on all adult participants with a history of any bariatric surgery who underwent liver transplantation between January 2017 and July 2022. Demographic information was obtained from recipients as well as from the donors. Outcome of interest was the modality in which the anastomotic biliary complications were managed.
Results:
Of 261 participants who underwent liver transplantation at our center during the study period, 9 had a history of bariatric surgery. ABC occurred in 3 (33%). There were no significant differences in donor age, ischemic time, etiology of liver disease, MELD-Na at time of transplant between the two groups. All ABC occurred in patients with a history of RYGB or BPD-DS. Interventions included advanced endoscopy, endoscopic ultrasound, and lumen-aposing metal stent to access the remnant stomach and biliopancreatic limb (n=2) and surgical revision following percutaneous transhepatic biliary drain placement (n=1). At time of study closure, none experienced recurrent stricture.
Conclusion:
Anastomotic biliary complications are well-described after liver transplantation. A multi-disciplinary approach with interventional radiology and interventional gastroenterology can be beneficial to address strictures that arise in patients with a history of RYGB or BPD-DS.