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. 2016 Apr;18(4):367-74.
doi: 10.1016/j.hpb.2015.10.012. Epub 2016 Jan 29.

Early biliary complications following pancreaticoduodenectomy: prevalence and risk factors

Brice Malgras  1 , Sandrine Duron  2 , Sébastien Gaujoux  3 , Safi Dokmak  3 , Béatrice Aussilhou  3 , Vinciane Rebours  4 , Maxime Palazzo  4 , Jacques Belghiti  3 , Alain Sauvanet  3
Affiliations

Early biliary complications following pancreaticoduodenectomy: prevalence and risk factors

Brice Malgras et al. HPB (Oxford). 2016 Apr.

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.

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Figures

Figure 1
Figure 1
Evolution of serum bilirubin levels (expressed in μmol/L) in patients with bilio-enteric stricture and transient jaundice (100 μmol/L = 5.9 mg/dL). TJ: transient jaundice; BES: bilio-enteric stricture; POD: postoperative day
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