Early biliary complications following pancreaticoduodenectomy: prevalence and risk factors

• Published in: HPB (Oxford, England) England), 2016-04, Vol.18 (4), p.367-374
• Main Authors: Malgras, Brice, Duron, Sandrine, Gaujoux, Sébastien, Dokmak, Safi, Aussilhou, Béatrice, Rebours, Vinciane, Palazzo, Maxime, Belghiti, Jacques, Sauvanet, Alain
• Format: Article
• Language: English
• Subjects: Aged; Anastomotic Leak - epidemiology; Anti-Bacterial Agents - therapeutic use; Biliary Tract Diseases - diagnosis; Biliary Tract Diseases - epidemiology; Biliary Tract Diseases - mortality; Biliary Tract Diseases - therapy; Chi-Square Distribution; Cholangitis - epidemiology; Cholestasis - epidemiology; Female; Gastroenterology and Hepatology; Humans; Incidence; Jaundice, Obstructive - epidemiology; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Original; Pancreaticoduodenectomy - adverse effects; Pancreaticoduodenectomy - mortality; Paris - epidemiology; Prevalence; Recurrence; Reoperation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1016/j.hpb.2015.10.012

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 in case of male gender, benign disease, malignancy with preoperative chemoradiation, and CBD ≤5 mm. Transient jaundice or cholangitis have a favorable outcome, whereas bilio-enteric stricture or biliary leak can require reintervention.