Early biliary complications following pancreaticoduodenectomy: prevalence and risk factors.

Abstract

BACKGROUND:

Early biliary complications (EBC) following pancreaticoduodenectomy (PD) are poorly known. This study aimed to assess incidence, predictive factors, and treatment of EBC including bilio-enteric stricture, transient jaundice, biliary leak, and cholangitis.

METHOD:

From 2007 to 2011, 352 patients underwent PD. Statistical analysis including logistic regression was performed to determine EBC predictive factors.

RESULTS:

49 patients (14%) developed 51 EBC, including 7(2%) bilio-enteric strictures, 15(4%) transient jaundices, 9(3%) biliary leaks, and 20(6%) cholangitis with no mortality and a 18% reoperation rate. In multivariate analysis, male gender, benign disease, malignancy with preoperative chemoradiation, and common bile duct (CBD) diameter ≤ 5 mm were predictive of EBC. Of the 7 strictures, all were associated with CBD ≤ 5 mm and 5(71%) required reoperation. Transient jaundice resolved spontaneously in all 15 cases. Among 8 patients with serum bilirubin level > 50 μmol/L (3 mg/dL) at POD3, 7(88%) developed bilio-enteric stricture. Biliary leak resolved spontaneously in 5(56%); otherwise, it required reoperation. Cholangitis recurred after antibiotics discontinuation in 5(25%).

CONCLUSIONS:

EBC following PD do not increase mortality. EBC are more frequent with male gender, benign disease, malignancy with preoperative chemoradiation, and CBD ≤ 5 mm. Transient jaundice or cholangitis has a favorable outcome, whereas bilio-enteric stricture or biliary leak can require reintervention.

• Authors: Brice Malgras, Sandrine Duron, Sébastien Gaujoux, Safi Dokmak, Béatrice Aussilhou, Vinciane Rebours, Maxime Palazzo, Jacques Belghiti, Alain Sauvanet
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 18 Issue 4 Pg. 367-74 (Apr 2016) ISSN: 1477-2574 [Electronic] England
• PMID: 27037207 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Aged
• Anastomotic Leak (epidemiology)
• Anti-Bacterial Agents (therapeutic use)
• Biliary Tract Diseases (diagnosis, epidemiology, mortality, therapy)
• Chi-Square Distribution
• Cholangitis (epidemiology)
• Cholestasis (epidemiology)
• Female
• Humans
• Incidence
• Jaundice, Obstructive (epidemiology)
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Pancreaticoduodenectomy (adverse effects, mortality)
• Paris (epidemiology)
• Prevalence
• Recurrence
• Reoperation
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome