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The Impact of Hepaticojejunostomy Leaks After Pancreatoduodenectomy: a Devastating Source of Morbidity and Mortality

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Hepaticojejunostomy leaks are less frequent than pancreatic leaks after pancreatoduodenectomy, and the current literature suggests comparable outcomes. The purpose of this study was to determine if the hepaticojejunostomy leak adversely affected patient outcomes.

Methods

Consecutive cases of pancreatoduodenectomy (n = 924) were reviewed at a single high-volume institution over an 8-year period (2006–2014).

Results

Pancreaticojejunostomy leaks were identified in 217 (23%) patients and hepaticojejunostomy leaks were identified in 24 patients (3%); combined hepaticojejunostomy/pancreaticojejunostomy leaks were identified in 31 patients (3%). Those with hepaticojejunostomy leaks or combined leaks had a significantly increased risk of morbidity when compared to pancreaticojejunostomy leaks or no leak (54 and 58 vs. 34 and 24%, respectively, p < 0.05). The median length of stay was significantly greater for hepaticojejunostomy leaks or combined leaks when compared to pancreatojejunostomy leaks (17 or 14 vs. 9 days, p = 0.001) and those with no leak (17 or 14 vs. 7 days, p = 0.001). Ninety-day mortality for all patients was 3.6%. Hepaticojejunostomy leaks and combined leaks significantly increased 90-day mortality rate (17 and 32%, respectively, p < 0.05).

Conclusions

Hepaticojejunostomy and combined leaks after pancreatoduodenectomy are rarer than pancreaticojejunostomy leaks; these patients are at a significantly increased risk of major morbidity and mortality.

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA

    Andrea L. Jester, Catherine W. Chung, David C. Becerra, E. Molly Kilbane, Michael G. House, Nicholas J. Zyromski, C. Max Schmidt, Attila Nakeeb & Eugene P. Ceppa

Authors
  1. Andrea L. Jester
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  2. Catherine W. Chung
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  3. David C. Becerra
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  4. E. Molly Kilbane
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  5. Michael G. House
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  6. Nicholas J. Zyromski
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  7. C. Max Schmidt
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  8. Attila Nakeeb
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  9. Eugene P. Ceppa
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Contributions

Drs. Jester, Chung, Becerra, and Ceppa designed the study, acquired data, performed data analysis, and drafted the manuscript. Mrs. Kilbane acquired data and critically reviewed the manuscript. Drs. House, Zyromski, Schmidt, and Nakeeb helped design the study, performed data analysis, and critically reviewed the manuscript. All authors gave final approval and are accountable for all aspects of the manuscript.

Corresponding author

Correspondence to Eugene P. Ceppa.

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Jester, A.L., Chung, C.W., Becerra, D.C. et al. The Impact of Hepaticojejunostomy Leaks After Pancreatoduodenectomy: a Devastating Source of Morbidity and Mortality. J Gastrointest Surg 21, 1017–1024 (2017). https://doi.org/10.1007/s11605-017-3406-1

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  • DOI: https://doi.org/10.1007/s11605-017-3406-1

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