Incidence and Risk Factors of Cholangitis after Hepaticojejunostomy
After hepatobiliary-pancreatic surgery, hepaticojejunostomy cholangitis is a rare condition; the true incidence rate of postoperative cholangitis is unknown. Therefore, our study aimed to determine the incidence rate and timing of postoperative cholangitis after biliary-enteric anastomosis, and to evaluate risk factors and management strategies.
Our single-center retrospective study included 583 patients who had undergone biliary-enteric anastomosis for hepatobiliary-pancreatic diseases. Demographic and treatment data were extracted from the medical records, and the association between potential risk factors and the development of postoperative cholangitis evaluated using a prospectively collected database.
Postoperative cholangitis developed in 45/583 patients (incidence rate, 7.7%), on average 18.3 ± 27.4 months (median = 6.9 months) after surgery. On multivariate analysis, the following factors were independently associated with postoperative cholangitis after biliary-enteric anastomosis: male sex, benign condition, and postoperative complication with a Clavien-Dindo classification grade > III. Among patients with postoperative cholangitis, a biliary stricture developed in 57.8% (26/45) of cases. Percutaneous balloon dilatation (73.1%) and endoscopic stenting (11.5%) were used as initial treatment of the stricture, with surgical revision being required in only 15.4% of cases of hepaticojejunostomy stricture.
Biliary-enteric anastomotic cholangitis after hepaticojejunostomy is a distinct disease process. Although non-operative management of postoperative cholangitis is successful in many cases, further research is required to better understand patient- and physician-related factors that predispose patients to postoperative cholangitis.
KeywordsHepaticojejunosotomy Cholangitis Stricture Surgery Outcome
This work was supported by a grant from the Kochi organization for medical reformation and renewal. Dr. Takehiro Okabayashi is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. T.O. and Y.S. contributed design of the work. T.S., K.S., J.I., and S.M. research data. T.I. analyzed data. T.O. wrote the manuscript and researched data. Y.S. reviewed/edited the manuscript. J.I., S.M., and Y.S. contributed to discussion and reviewed/edited the manuscript.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
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