Abstract
Background
The aim of this study was to determine the incidence and predisposing factors of biliary complications (BCs) after pancreaticoduodenectomy (PD) and report our experience in managing these BCs. Pancreatic surgery, particularly PD, has benefited from improvements in operative techniques and postoperative care and is currently safer in terms of mortality. However, the morbidity associated with PD remains high, including frequent complications such as delayed gastric emptying and pancreatic fistulas. Rarer but important BCs are those that manifest as bile leaks (BLs) and biliary strictures (BSs).
Methods
Between April 2005 and December 2011, a total of 397 patients underwent PD at two centers. All data were retrospectively studied with respect to age, gender, pancreatic pathology, neoadjuvant treatment, preoperative biliary stenting, intraoperative data, postoperative pancreatic fistula, BL and BS rates, and mortality. The management of BCs was also analyzed.
Results
Thirty patients experienced a BC: 13 BLs (3.3 %) and 17 BSs (4.3 %). A thin bile duct (<5 mm), measured during surgery, was the only predisposing factor for developing a BL or a BS. The management of the BLs consisted of surveillance in six patients (46 %), percutaneous drainage of bilioma in four patients (31 %), and reintervention in three patients (23 %). No patient with a BS had surgery as the frontline treatment: the initial management consisted of an endoscopic procedure, a percutaneous procedure, or medical treatment. Four patients (23.5 %) underwent surgical treatment after failure of nonsurgical procedures.
Conclusions
The only identified predictive factor of BC, either a BS or a BL, was a thin bile duct. Although the noninvasive technique was the treatment of choice initially, reintervention was required in almost 25 % of the cases.
Similar content being viewed by others
References
Birkmeyer JD, Warshaw AL, Finlayson SR et al (1999) Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery 126:178–183
Ho V, Heslin MJ (2003) Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg 237:509–514
Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–260
Bassi C, Falconi M, Salvia R et al (2001) Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients. Dig Surg 18:453–458
Rios G, Conrad A, Cole D et al (1999) Trends in indications and outcomes in the Whipple procedure over a 40-year period. Am Surg 65:889–893
Balcom JH, Rattner DW, Warshaw AL et al (2001) Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136:391–398
House MG, Cameron JL, Schulick RD et al (2006) Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 243:571–578
Reid-Lombardo KM, Ramos-De la Medina A, Thomsen K et al (2007) Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg 11:1704–1711
Antolovic D, Koch M, Galindo L et al (2007) Hepaticojejunostomy–analysis of risk factors for postoperative bile leaks and surgical complications. J Gastrointest Surg 11:555–561
Buchler MW, Wagner M, Schmied BM et al (2003) Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg 138:1310–1315
Yeo CJ, Cameron JL, Lillemoe KD et al (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 236:355–368
Behrman SW, Mulloy M (2006) Total pancreatectomy for the treatment of chronic pancreatitis: indications, outcomes, and recommendations. Am Surg 72:297–302
Buchler MW, Friess H, Wagner M et al (2000) Pancreatic fistula after pancreatic head resection. Br J Surg 87:883–889
Imanaga H (1960) A new method of pancreaticoduodenectomy designed to preserve liver and pancreatic function. Surgery 47:577–586
Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Sohn TA, Yeo CJ, Cameron JL et al (2003) Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 7:209–219
Gervais DA, Fernandez-del Castillo C, O’Neill MJ et al (2001) Complications after pancreatoduodenectomy: imaging and imaging-guided interventional procedures. Radiographics 21:673–690
Moore AV Jr, Illescas FF, Mills SR et al (1987) Percutaneous dilation of benign biliary strictures. Radiology 163:625–628
Vos PM, van Beek EJ, Smits NJ et al (2000) Percutaneous balloon dilatation for benign hepaticojejunostomy strictures. Abdom Imaging 25:134–138
Schumacher B, Othman T, Jansen M et al (2001) Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy. Endoscopy 33:409–415
Acknowledgments
We thank Diane Mege for her contribution to this work
Conflict of interest
The authors have no conflicts of interest to declare. This study was not supported by any Grant.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Duconseil, P., Turrini, O., Ewald, J. et al. Biliary Complications After Pancreaticoduodenectomy: Skinny Bile Ducts Are Surgeons’ Enemies. World J Surg 38, 2946–2951 (2014). https://doi.org/10.1007/s00268-014-2698-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-014-2698-5