Purpose: Biliary complications after hepatopancreaticobiliary (HPB) surgeries are between 2-15%, whereas after liver transplants (LT) the rate is around 15-65%. Various suture techniques, internal and external stents have been used in the literature to prevent biliary leaks. We evaluated the preventive effect of double J stents (djs) placed in the biliary anastomosis on biliary leakage.
Methods: Since November 2022, we used 4Fr X 12cm DJS in the biliary anastomosis of 55 LT and 8 HPB patients. Of these 55 LT patient, 13 were pediatric.  Biliary anastomosis was performed using a 2.5 magnifying surgical loupe, via end bile duct to side Roux-en-Y hepaticojejunostomy (n = 15), hepaticoduodenostomy (n=8), and duct-to-duct choledochocholedochostomy (n=40). We performed interrupted suture with 6-0 absorbable material. After complete posterior row, we inserted djs into the intrahepatic bile duct. After that we complete the anastomosis with interrupted sutures of the anterior wall. In biliary anastomoses with multiple ducts, djs were placed separately in each duct.
Results: We used 69 DJS in the biliary anastomosis of 63 patients. In LT patients 51 patients were living donor LT. Seven were auxiliary partial orthotopic LT and 2 were domino LT. Six graft had two bile ducts. Bile leakage from the anastomosis was observed only in 5 LT patients. In two patient with anastomotic leakage, DJS was endoscopically removed and an internal stent was placed. In the other two patients with anastomotic leakage, the djs was removed and a PTK drain was placed. In one patients, we operated for biliary leakage, reinserted DJS and performed primary repair of the anastomotic line. None of the HPB patients developed any complications.
Conclusion: In biliary anastomoses and reconstructions, DJS can be safely used to prevent anastomotic leaks in both pediatric and adult patients, regardless of graft type and anastomosis technique.