*Purpose: Because of the innovations in surgical and postoperative surgical treatment of donors and recipients during the past decade, living donor liver transplantation (LDLT) is widely used as a major treatment modality for end-stage liver disease, hepatocellular carcinoma, and acute hepatic failure. Despite these advances, biliary complication is still considered to be a technical “Achilles’ heel” of LDLT due to the high incidence, requiring long-term interventional treatment, and potential risk for potential graft failure. The purpose of this study was to evaluate the effectiveness of internal stent for duct-to-duct anastomosis in LDLT.

*Methods: From December 2016 to October 2018, LDLT was performed in 91 patients in our center. Duct-to-duct anastomosis was performed in all LDLT patients and ductal anastomosis was performed by single surgeon. The internal stent was a silicone tube of various diameters considering the duct size. Biliary complications were diagnosed as anastomosis leakage by bile color of drainage fluid and anastomosis stricture when endoscopic retrograde biliary drainage (ERBD) or percutaneous transhepatic biliary drainage (PTBD) was inserted due to intrahepatic duct dilatation and hyperbilirubinemia during follow-up period.

*Results: In all patients with LDLT, biliary complications occurred in 22 (24.2%) patients and anastomosis site leakage occurred in 8 (8.8%) patients. Among 8 patients, four (4.4%) patients required interventional treatment. Their mean age was 56.6 ± 8.2 years and 61 (67.0%) were male. There were 59 (64.8%) cases with one duct opening in the graft, 29 (31.9%) cases with 2 duct openings, and 3 (3.3%) cases with 3 duct openings. Leakage occurred in 3 (5.1%) cases with 1 duct opening and leakage occurred in 5 (15.6%) cases with 2 or more duct openings. Of the 91 patients, non-stent group was 48 (52.7%) patients and stent group was 43 (47.3%) patients. Anastomosis site leakage was higher in the non-stent group (n=5, 10.4%) than in the stent group (n=3, 7.0%), although there was no statistical difference (p=0.563). Biliary complications were also higher in the non-stent group (n=15, 31.3%) than in the stent group (n=7, 16.3%), although there was no statistical difference (p=0.096). In univariate analysis, the ischemic time was longer in the leakage group (p = 0.05), the operation time was longer in the biliary complications group (p = 0.01).

*Conclusions: Although there was no statistically significant difference due to small case number, when internal stent was inserted, biliary complications including anastomosis leakage were reduced compared to no insertion. Further large-scale analyses of clinical data are required to support this study.

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