The use of anastomotic stent in bilio digestive anastomosis depends on multiples factors

The aim is to rduce the incidence of leakage and subsequently the rate of stenosis

So the indicatiin depends on the qulity of making such type of anastomosis and subsequently if there is some predictive factors of leakage or stonosi on making the anastomosis

Elective surgery or emrgency are not the same indications

The principal factors is the quality of the biliary stump, its vasclar support,

The level of such anastomosis from the superior bifurcation

The respect of the good anastomisis, tension free, stump bleeding, extra mucosae in the biliary tract,

The diamatre of thebiliary stump, if itis less than 4 mm, theanastomosis will be difficult and a trans anastomtic drainage will be efficaceous

Emergency anastomosis, like in the setting of bile duct injury with or without vascular injury, arterail support, dictate the succes of the anastomsis

Wich tye of drainage,Voelker or praderi are similar. They permit a progreesive healing and the possibility of radiological control

thanks Dr.Jarbouli.I think one of the most important indication for transanastomtic stent is circumstance when we can not anatstomose between mocusa of small bowel and bile duct ,for example in patient with bile duct injury to rigth posterior sectional duct that dicover after several month .in this patient stent permit growth mucosa toward eachother, the same as enterocutaneous fistula after colonic anastomotic breakdown that fistulous tract was exist.what is your idea?

I think the only good indication for transanastomotic stent in bile-duct anastomosis today is when creating hepato-jejunostomy with very small-sized intrahepatic ducts at the cut liver surface.

Again, I think that in this issue the single Center or Surgeon experience play a big role. In my opinion, excluding some complicated multiple bile duct reconstruction, the stend is not mandatory.

I agree completely Marco,

And when we look at the literature there are generally 3 groups of patients requiring bilio-enteric anastomosis: in liver transplantation, bile duct injury, primary after BD resection/transection. What we see if take a look separately in these groups? In LTx there is a strong tendency an some evidence that no-stent policy is superior. And in latter two groups even if the evidence is scarce the benefit of general no-stent policy and very selective stenting is considered now. Finally the decision to stent or not seems to gradually changes with growing experience. There are several papers on the subject, and I can recommend some of them:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3238010/pdf/hpb0013-0767.pdf

http://www.cmj.org/Periodical/PDF/201271751715480.pdf

When there are signes of biliary hypertension