Efficacy of Percutaneous Transhepatic One-Stage Biliary Fistulization for Biliary Stricture with Hepatolithiasis after Liver Transplantation

Li Yi; Sangui Wang; Xiaoling Zhang; Quanlei Wang; Ping Wang

doi:10.3791/71550

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Research Article

Efficacy of Percutaneous Transhepatic One-Stage Biliary Fistulization for Biliary Stricture with Hepatolithiasis after Liver Transplantation

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DOI:

10.3791/71550

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June 16th, 2026

Li Yi^*¹^,²^,³ , Sangui Wang^*²^,³ , Xiaoling Zhang^*³^,⁴ , Quanlei Wang²^,³ , Ping Wang¹

¹Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou Medical University, ²Department of Hepatobiliary Surgery, Nancheng Hospital (Hepatobiliary Hospital), ³Dongguan Institute of Gallbladder Disease Research, Nancheng Hospital (Hepatobiliary Hospital), ⁴Department of Nursing, Nancheng Hospital (Hepatobiliary Hospital)

^* These authors contributed equally

Summary

This retrospective single‑center study evaluated percutaneous transhepatic one-stage biliary fistulization (PTOBF) in 25 post‑liver transplant patients with biliary stricture and stones. In this small cohort, PTOBF was associated with favorable stricture resolution and stone clearance rates, suggesting significant clinical potential. Prospective studies are needed to confirm efficacy and safety.

Abstract

With the increasing maturity of percutaneous transhepatic cholangioscopy and biliary drainage techniques, PTOBF has gradually emerged as a novel minimally invasive treatment for biliary strictures and hepatolithiasis. This retrospective single‑center study included 25 post‑liver transplant patients diagnosed with biliary strictures and stones between January 2022 and December 2025, aiming to further evaluate the clinical efficacy and safety of PTOBF. The degree of stricture, distribution of stones, total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), fibrinogen (FIB), γ-glutamyl transpeptidase (r-GGT), prothrombin time (PT), C-reactive protein(CRP), postoperative complication rate, stricture resolution rate, and stone clearance rate, etc., were analyzed. A total of 73 PTOBF procedures were performed on the 25 patients to manage strictures. The mean bile duct diameter after dilatation was 5.472 ± 0.667 mm. The stricture resolution rate was 92.0% (23/25). During a mean follow-up period of 19.1 ± 8.2 months, the final stone clearance rate was 88.0% (22/25). Compared with preoperative levels, postoperative levels of DBIL, ALT, AST, and FIB were significantly reduced. In this small retrospective cohort, PTOBF was associated with favorable stricture resolution and stone clearance rates, suggesting significant clinical potential. Prospective studies are needed to confirm efficacy and safety.

Introduction

In 1963, the world's first liver transplantation was performed by Professor Starzl, known as the "Father of Liver Transplantation"¹. With rapid technological advancements, liver transplantation has become a common treatment modality for various end-stage liver diseases²^,³. However, a frequent complication following liver transplantation is biliary stricture, with an incidence rate of approximately 15–30%⁴, of which over 80% occur at anatomical locations such as the biliary anastomosis⁵. Biliary strictures can secondarily ....