Complications of transplantation
Case report
Magnetic Compression Anastomosis for Bile Duct Stenosis After Donor Left Hepatectomy: A Case Report

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Abstract

Magnetic compression anastomosis (MCA) provides a minimally invasive treatment creating a nonsurgical, sutureless enteric anastomosis in conjunction with an interventional radiologic technique by using 2 high-power magnets. Recently, the MCA technique has been applied to bile duct strictures after living donor liver transplantation or major hepatectomy. Herein we described use of MCA for bile duct stenosis 5 months after donor left hepatectomy in a 24-year-old man who presented with a stricture at the porta hepatis and intrahepatic bile duct dilatation. Unsuccessful transpapillary biliary drainage and balloon dilatation through a percutaneous transhepatic biliary drainage (PTBD) route led to the MCA. A 4-mm-diameter cylindrical samarium-cobalt (Sm-Co) daughter magnet with a long nylon wire was placed at the superior site of the obstruction through the PTBD route. A 5-mm-diameter Sm-Co parent magnet with an attached nylon handle was endoscopically inserted into the common bile duct and placed at the inferior site of obstruction. The 2 magnets were attracted, sandwiching the stricture and establishing a reanastomosis. In conclusion, the MCA technique was a unique procedure for choledochocholedochostomy in a patient with bile duct stenosis after donor hepatectomy.

Section snippets

Case Report

A 24-year-old man had undergone a donor left hepatectomy for his mother's liver transplantation. He subsequently suffered leakage at the bile duct stump, which resolved after percutaneous abdominal and endoscopic nasobiliary drainages. He began to experience fever with slight elevation of transaminases (aspartate aminotransferase, 79 IU/L; alanine aminotransferase, 109 IU/L) and total bilirubin (1.2 mg/dL) at 5 months after the hepatectomy. Magnetic resonance cholangiopancreatography revealed a

Discussion

Donor safety is a critical issue in LDLT. Biliary complications, a major concern among LDLT donors, have been reported to range from 3.2%–5.5%.3, 4, 5 Treatments for biliary complications include percutaneous abdominal drainage, percutaneous or endoscopic biliary drainage, balloon dilatation, and stent placement. However, if these therapies fail, one must consider surgical revision of the bile duct anastomosis. MCA developed by Yamanouchi et al6, 7 is a unique procedure to perform an alimentary

References (7)

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    One magnet was delivered via percutaneous transhepatic biliary drainage tract, and the other was advanced through endoscopic retrograde cholangiopancreatography scope. Afterward, the two magnets mated and recanalized the bile ducts.38-43 Avaliani et al.7 has reported MCA between bile ducts and duodenum as a palliative treatment of malignant obstructive jaundice.

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    In the present case, the patient removed the stent herself early after treatment, which might have caused anastomotic stricture after LDLT. In the English literature, a total of 5 patients with MCA after LDLT have been reported [3,5,8,9,12]. Four of those cases, like the present case, were LDLT of the right lobe (Table 1).

  • Treatment of completely obstructed benign biliary strictures with magnetic compression anastomosis: follow-up results after recanalization

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    Of the patients in whom stenosis recanalization was successful, one died due to transplant rejection. In refractory BBSs that cannot be resolved by conventional endoscopic or percutaneous methods, the feasibility and safety of MCA have been established by various experimental and clinical studies.10-23,26-29 In animal studies, new fistulas formed by MCA are intact in the serosal, submucosal, and mucosal layers,28,29 and patency is similar to anastomoses formed using conventional surgery.30

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    Seventeen cases of complete biliary obstruction after liver transplantation treated with MCA have been reported. Five were isolated case reports and recanalization was achieved in all of them.4-6,8,11 No recurrence was reported after a follow-up period of 2 months to 3 years.

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