Background : Postoperative bile leak is one of troublesome complications after living donor liver transplantation (LDLT). It usually needs percutaneous drainage (PCD) and interventional biliary stenting although minor leak may be resolved spontaneously. This study shows our experience on early PCD removal after tract embolization despite large amounts of drainage.

Methods : We retrospectively reviewed patients who underwent LDLT between March 2012 and December 2021. When post-transplant bile leak developed we usually inserted PCD for intra-abdominal bile collection and placed biliary stent through the endoscopic or transhepatic approach. Although PCDs were removed after bile leakage was resolved, we also tried to remove PCD early after fistula tract embolization in some patients with a high output biliary leakage if the controlled fistula tract was formed.

Results : Among 118 LDLT patients, bile leak occurred in 12 (10.2%) patients. All patients with bile leak received endoscopic or radiologic interventions for biliary stenting and 9 patients (75%) also needed PCD insertion. In 4 patients, PCDs were removed after bile leak was resolved. However, 5 patients (55.5%) had a lasting amount of bile leakage before removal of PCD. There were no severe complications; one patient had intercostal artery bleeding during the procedure; one, cholangitis, and one, stent migration. In addition, no recurrent bile leak requiring re-insertion of PCD developed after this treatment.

Conclusions : This case series shows that PCD for bile leakage after LDLT could be removed early with tract embolization following internal stent insertion. It does not increase the morbidity of patients and can improve their quality of life.