Postoperative biliary anastomotic strictures after pancreaticoduodenectomy

Javed, Ammar A.; Mirza, Muhammad Bilal; Sham, Jonathan G.; Ali, Daniyal M.; Jones, George Fenwick; Sanjeevi, Srinivas; Burkhart, Richard A.; Cameron, John L.; Weiss, Matthew J.; Wolfgang, Christopher L.; He, Jin

doi:10.1016/j.hpb.2021.04.008

Cited by 15 publications

(10 citation statements)

References 19 publications

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“…The rate of benign HJAS and the time from PD to HJAS has been reported to be 2.6%–13.0% and 7.2–23.4 months, respectively, which are consistent with our results 9–13,17 . The rate of surgical re‐anastomosis was reported to be 4.8%–23.5% 3,9,13 .…”

Section: Discussionsupporting

confidence: 91%

“…[10][11][12] Small preoperative bile duct diameter, high body mass index, preoperative biliary drainage, long operating time, postoperative pancreatic fistula, postoperative bile leak, benign lesions, and administration of adjuvant radiation therapy are reported risk factors for benign HJAS. [9][10][11][12]17 In this study, lack of preoperative biliary drainage, preoperative bile duct diameter <5 mm, and former or current smoking were identified as independent risk factors for benign HJAS. The cut-off value used for preoperative bile duct diameter varies from 4-8 mm in previous reports, but we used 5 mm based on our receiver operating characteristic curve.…”

Section: Discussionmentioning

confidence: 73%

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Impact of preoperative self‐expandable metal stent on benign hepaticojejunostomy anastomotic stricture after pancreaticoduodenectomy

Mie,

Sasaki,

Kobayashi

et al. 2023

DEN Open

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ObjectivesHepaticojejunostomy anastomotic stricture (HJAS) is a serious adverse event of pancreaticoduodenectomy. Preoperative biliary drainage with a self‐expandable metal stent (SEMS) is often performed before pancreaticoduodenectomy. The purpose of this study is to evaluate the risk factors and impact of preoperative SEMS placement on developing benign HJAS after pancreaticoduodenectomy.MethodsWe retrospectively analyzed consecutive patients who underwent pancreatoduodenectomy at our institution between July 2014 and June 2020. Risk factors for benign HJAS were identified using univariate and multivariate logistic regression analysis. We also compared outcomes of preoperative biliary drainage using SEMS and non‐SEMS.ResultsOf the 626 included patients, benign HJAS occurred in 36 patients (5.8%). The median follow‐up time was 36.7 months (interquartile range, 25.4–57.4 months). Multivariate logistic regression analysis revealed that lack of preoperative biliary drainage, preoperative bile duct diameter <5 mm, and former or current smoking were independent predictors of benign HJAS. In the preoperative biliary drainage group, the rate of preoperative bile duct diameter <5 mm was significantly lower in the SEMS group than in the non‐SEMS group (2.0% vs. 12.8%, p = 0.04).ConclusionsPreoperative biliary drainage with SEMS may be useful to maintain bile duct diameter ≥5 mm and to reduce benign HJAS as a result.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 73%

Impact of preoperative self‐expandable metal stent on benign hepaticojejunostomy anastomotic stricture after pancreaticoduodenectomy

Mie,

Sasaki,

Kobayashi

et al. 2023

DEN Open

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“…In the present study, 4 − 0 prolene was used for the anastomosis, and the biliary stents were xed to the jejunal wall using 4 − 0 vicryl. Vicryl sutures, which becomes completely absorbed within 60-90 days, are often used for bile duct reconstruction, since these can decrease the incidence of early postoperative bile duct strictures and stone formation [18,19]. However, vicryl sutures are not smooth enough to slide through tissue, and are not preferred for continuous sutures, especially when the surgical eld is di cult to expose.…”

Section: Discussionmentioning

confidence: 99%

Modified Technique of Hepatojejunostomy for Biliary Tract Reconstruction After Resection of Perihilar Tumors: A case series

Kuang,

Ji,

Yuan

et al. 2023

Preprint

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Backgrounds:Radical resection is the most effective treatment for hilar cholangiocarcinoma. Biliary tract reconstruction after resection is one of the key steps in this surgery. Mucosa-to-mucosa cholangiojejunostomy is traditionally performed, in which the bile ducts at the resection margin are separately anastomosed to the jejunum. However, this approach is associated with long operative time and high risk of postoperative complications. The present study presents a modified technique of hepatojejunostomy, and its outcomes. Methods:The data of patients who underwent hepatojejunostomy using the modified technique at the Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China, from January 2016 to December 2021, were retrospectively analyzed. Results:A total of 13 patients with perihilar tumors underwent R0 resection and bilioenteric reconstruction using the modified hepatojejunostomy technique during the study period. During the operation, the alignment of the bile duct stumps was improved, the posterior wall of the anastomosis was reinforced, internal stents were placed in the smaller bile ducts, external stents were placed in the larger bile ducts, and hepatojejunostomy was performed using 4-0 prolene. No serious postoperative complications, such as death or bile leakage, occurred during the hospitalization. Furthermore, there were no cases of biliary stricture or cholangitis after the six-month follow-up period. Conclusion:The modified hepatojejunostomy technique is a safe and effective technique of biliary reconstruction after the resection of perihilar tumors. This can be easily performed for difficult cases with multiple bile ducts that require reconstruction after resection.

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“…[12][13][14] Other less frequent complications that occur after PD or TP include liver ischemia, gastric complications, and leakage of the biliodigestive anastomosis. [15][16][17][18] During PD, the blood supply to the pancreatic head is dissected, particularly the gastroduodenal artery (GDA) and the inferior pancreaticoduodenal artery. Dissecting these collaterals between the celiac artery and the superior mesenteric artery may affect the blood flow in both vessels.…”

mentioning

confidence: 99%

“…12–14 Other less frequent complications that occur after PD or TP include liver ischemia, gastric complications, and leakage of the biliodigestive anastomosis. 15–18…”

mentioning

confidence: 99%

Celiac Axis Stenosis is an Underestimated Risk Factor for Increased Morbidity After Pancreatoduodenectomy

et al. 2022

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Objective: To assesses the prevalence and severity of CAS in patients undergoing PD/total pancreatectomy and its association with major postoperative complications after PD. Summary of background data: CAS may increase the risk of ischemic complications after PD. However, the prevalence of CAS and its relevance to major morbidity remain unknown. Methods: All patients with a preoperative computed tomography with arterial phase undergoing partial PD or TP between 2014 and 2017 were identified from a prospective database. CAS was assessed based on computed tomography and graded according to its severity: no stenosis (<30%), grade A (30%–<50%), grade B (50%–≤80%), and grade C (>80%). Postoperative complications were assessed and uni- and multivariable risk analyses were performed. Results: Of 989 patients, 273 (27.5%) had CAS: 177 (17.9%) with grade A, 83 (8.4%) with grade B, and 13 (1.3%) with grade C. Postoperative morbidity and 90-day mortality occurred in 278 (28.1%) patients and 41 (4.1%) patients, respectively. CAS was associated with clinically relevant pancreatic fistula (P=0.019), liver perfusion failure (P=0.003), gastric ischemia (P=0.001), clinically relevant biliary leakage (P=0.006), and intensive care unit (P=0.016) and hospital stay (P=0.001). Multivariable analyses confirmed grade B and C CAS as independent risk factors for liver perfusion failure; in addition, grade C CAS was an independent risk factor for clinically relevant pancreatic fistula and gastric complications. Conclusions: CAS is common in patients undergoing PD. Higher grade of CAS is associated with an increased risk for clinically relevant complications, including liver perfusion failure and postoperative pancreatic fistula. Precise radiological assessment may help to identify CAS. Future studies should investigate measures to mitigate CAS-associated risks.

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Postoperative biliary anastomotic strictures after pancreaticoduodenectomy

Cited by 15 publications

References 19 publications

Impact of preoperative self‐expandable metal stent on benign hepaticojejunostomy anastomotic stricture after pancreaticoduodenectomy

Impact of preoperative self‐expandable metal stent on benign hepaticojejunostomy anastomotic stricture after pancreaticoduodenectomy

Modified Technique of Hepatojejunostomy for Biliary Tract Reconstruction After Resection of Perihilar Tumors: A case series

Celiac Axis Stenosis is an Underestimated Risk Factor for Increased Morbidity After Pancreatoduodenectomy

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