Biliary leakage following pancreaticoduodenectomy: Prevalence, risk factors and management

Nakeeb, Ayman El; Sorogy, Mohamed El; Hamed, Hosam; Said, Rami; Elrefai, Mohamed; Ezzat, Helmy; Askar, Waleed; Elsabbagh, Ahmed

doi:10.1016/j.hbpd.2018.10.005

Cited by 28 publications

(28 citation statements)

References 29 publications

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“…Biliary fistula (BF) is a rare problem that reportedly occurred in 3-8% of patients after PD and scanty attention were paid to it. The bile mixed with intestinal leak from the cholangio-intestinal anastomosis promotes bacterial infection and increases the additional morbidity and mortality (41,42). The present study demonstrated similar results, with BF occurs in 6.9% of patients and a 3.7-fold increased risk of additional infections complications.…”

Section: Discussionsupporting

confidence: 82%

Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy

Fang¹,

Yang²,

Liang³

et al. 2021

Gland Surg

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Background: Although the mortality of pancreaticoduodenectomy (PD) has decreased, the morbidity especially infections is still a severe challenge. This study aimed to identify the risk factors and microbial spectrum for infectious complications after PD.Methods: This retrospective study of 291 consecutive patients who underwent PD between February 2018 and March 2021 was conducted. The clinical data was reviewed and risk factors associated with infectious complications were analyzed. To investigate the microbial spectrum, microorganisms isolated from preoperative bile, drainage fluid and blood were counted.Results: A total of 110 patients (37.8%) developed postoperative infections. The patients who suffered infections had higher severe complications, prolonged hospitalization and increased expenditures. Three independent risk factors were identified: preoperative biliary drainage (PBD) [odds ratio (OR) 2.082; 95% confidence interval (CI): 1.059-4.091; P=0.033], clinically relevant postoperative pancreatic fistula (CR-POPF) (OR 11.984; 95% CI: 6.556-21.471; P=0.000) and biliary fistula (BF) (OR 3.674; 95% CI: 1.218-11.084; P=0.021). K. pneumoniae and E. faecalis were the most frequently isolated bacteria in preoperative bile and drainage fluid after PD. K. pneumoniae and S. haemolyticus were the most common bacteria in bacteremia patients.Conclusions: PBD, POPF and BF are independent risk factors for infectious complications after PD. To lower the incidence of infection, PBD should be performed only in select cases and efforts should be taken to reduce the POPF and BF. The pathogens of bile and drainage fluid should be monitored throughout the hospital stay.

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Section: Discussionsupporting

confidence: 82%

Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy

Fang¹,

Yang²,

Liang³

et al. 2021

Gland Surg

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“…Eine Insuffizienz der biliodigestiven Anastomose (BDA) kann in 5-10 % der Fälle nach einer Pankreaskopfresektion vorkommen [23]. Einer der häufigsten Gründe für eine Insuffizienz der BDA ist eine Durchblutungsstörung am Gallengang.…”

Section: Galleleckageunclassified

Komplikationsmanagement nach Pankreaseingriffen

Demir¹,

Demir²,

Frieß³

2020

Allgemein- und Viszeralchirurgie up2date

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“…However, the development of BF increases the risk of sequelae such as intraabdominal abscesses and biliary peritonitis with an extended hospital stay and increased mortality. 4 Thus, more attention must be given to BF and ways to reduce prevalence.…”

Section: Introductionmentioning

confidence: 99%

“…Excessive skeletonization of the hepatic duct, a small duct diameter, as well as anastomosis to the common bile duct (CBD) rather than the common hepatic duct (CHD) are among the known risk factors. 4–6 Reconstruction techniques, percutaneous biliary drainage, and intraoperative T-tube placement are among many attempted protective measures with little success. 4 , 7 Preoperative prediction of BF could be advantageous, allowing for early management, but has not been thoroughly assessed for PD.…”

Section: Introductionmentioning

confidence: 99%

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Biliary Leakage Following Pancreatoduodenectomy: Experience from a High-Volume Center

Farooqui

Penninga

Burgdorf

et al. 2021

Journal of Pancreatic Cancer

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Purpose: Hepaticojejunostomy leak and bile fistula after pancreaticoduodenectomy (PD) are less frequent than pancreatic leaks. Patients with biliary fistula (BF) have an increased risk of serious complications and an extended hospital stay. This study has investigated the occurrence and outcome of BF. Methods: All patients who underwent a PD from January 1st, 2015 to December 31st, 2019 were included. The significance of multiple risk factors was examined. Univariate analysis was used to identify predictive variables for postoperative BF. Results: Of the 552 patients who underwent PD, 38 patients (6.7%) developed a BF. Patients with nonmalignant diagnoses and malignancies without bile duct obstruction had a greater risk of developing BF. BF did not increase the mortality, though most patients had complications, including surgical site infections, intraabdominal abscesses, and an extended hospital stay. Conclusion: BF after PD leads to an increased risk of subsequent complications and an extended hospital stay but does not increase mortality. Patients with nonmalignant diagnoses and malignancies without bile duct obstruction have an increased risk of BF.

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Biliary leakage following pancreaticoduodenectomy: Prevalence, risk factors and management

Cited by 28 publications

References 29 publications

Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy

Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy

Komplikationsmanagement nach Pankreaseingriffen

Biliary Leakage Following Pancreatoduodenectomy: Experience from a High-Volume Center

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