Percutaneous Placement of Customised Plastic Biliary Stents with Internal-External Drainage in Liver Transplant Recipients with Roux-en-Y Hepaticojejunostomy: A Novel Approach for Managing Benign Biliary Strictures: A retrospective study

Background: To evaluate the feasibility, safety, and clinical efficacy of a novel percutaneous technique for treating benign biliary strictures in liver transplant (LT) recipients with Roux-en-Y hepaticojejunostomy, utilizing a handmade plastic biliary stent (PBS) in combination with an internal-external biliary drainage catheter. Methods: This retrospective study included 16 LT recipients with Roux-en-Y hepaticojejunostomy who developed benign biliary strictures and were treated percutaneously between January 2011 and January 2024. A customised PBS, created from a drainage catheter and affixed to an internal-external biliary catheter using a surgical suture, was deployed via a single transhepatic approach. Outcomes assessed included technical and clinical success, complication rates, stent patency, and the need for surgical revision. Results: Technical and clinical success was achieved in all patients (100%). All patients were successfully managed percutaneously. The mean primary stent patency duration was 952 days. No major complications or stent migrations occurred. Minor complications were observed in three patients (18.7%) and were managed conservatively. Conclusions: This novel percutaneous technique, combining a handmade plastic stent with internal-external drainage through a single tract, offers a safe, effective, and durable solution for managing post-transplant biliary strictures in patients with Roux-en-Y reconstruction. Its technical simplicity, high success rate, and suitability for complex anatomies make it a valuable alternative when endoscopic access is not feasible.