Skip to main content
SpringerLink
Log in

Refractory Long-Term Cholangitis After Pancreaticoduodenectomy: A Retrospective Study

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Postoperative cholangitis is one of the major late complications after pancreaticoduodenectomy (PD), and recurrent cholangitis has a negative impact on patients’ quality of life. However, detailed reports are scarce. The aim of this study was to investigate the clinical features of postoperative cholangitis after PD.

Methods

Between January 2007 and December 2013, 155 consecutive patients underwent PD. Of these, 113 patients were included in this study. Cholangitis was diagnosed according to the criteria in the revised Tokyo Guidelines 2013, and repeated cholangitis with three or more episodes was defined as ‘refractory cholangitis’. Data from patients with refractory cholangitis were retrospectively analyzed.

Results

Refractory cholangitis was observed in 21 patients (18.6%). Of these, 17 patients experienced cholangitis within 1 year after PD, and 10 patients had biliary strictures. These patients required an average of two interventional or endoscopic treatments for stricture dilatation, which led to remission. The 2-year cumulative incidence rate for refractory cholangitis was 18.9% (95% CI 11.65–26.15). Multivariate analysis revealed five risk factors for developing refractory cholangitis: benign disease (odds ratio [OR] 18.52; P = 0.001), long operation time (OR 18.73; P = 0.002), elevated C-reactive protein (OR 6.55; P = 0.014), elevated alkaline phosphatase (OR 6.03; P = 0.018), and the presence of pneumobilia (OR 28.81; P = 0.009).

Conclusions

Postoperative refractory cholangitis after PD usually developed within a year. Almost half of the patients had biliary strictures, and aggressive dilatation might be effective to achieve remission in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cameron JL, He J (2015) Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg 220:530–536

    Article  PubMed  Google Scholar 

  2. Ahmad SA, Edwards MJ, Sutton JM et al (2012) Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg 256:529–537

    Article  PubMed  Google Scholar 

  3. Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–257 (discussion 257–260)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Amini N, Spolverato G, Kim Y et al (2015) Trends in hospital volume and failure to rescue for pancreatic surgery. J Gastrointest Surg 19:1581–1592

    Article  PubMed  Google Scholar 

  5. Kimura W, Miyata H, Gotoh M et al (2014) A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 259:773–780

    Article  PubMed  Google Scholar 

  6. Keck T, Wellner UF, Bahra M et al (2016) Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction after PANCreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg 263:440–449

    Article  PubMed  PubMed Central  Google Scholar 

  7. Prawdzik C, Belyaev O, Chromik AM et al (2015) Surgical revision of hepaticojejunostomy strictures after pancreatectomy. Langenbecks Arch Surg 400:67–75

    Article  PubMed  Google Scholar 

  8. Kang CM, Lee JH (2015) Pathophysiology after pancreaticoduodenectomy. World J Gastroenterol 21:5794–5804

    Article  PubMed  PubMed Central  Google Scholar 

  9. Nomura R, Ishizaki Y, Suzuki K et al (2007) Development of hepatic steatosis after pancreatoduodenectomy. Am J Roentgenol 189:1484–1488

    Article  Google Scholar 

  10. House MG, Cameron JL, Schulick RD et al (2006) Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 243:571–576 (discussion 576–578)

    Article  PubMed  PubMed Central  Google Scholar 

  11. Duconseil P, Turrini O, Ewald J et al (2014) Biliary complications after pancreaticoduodenectomy: skinny bile ducts are surgeons’ enemies. World J Surg 38:2946–2951

    Article  PubMed  Google Scholar 

  12. Yamaguchi K, Tanaka M, Chijiiwa K et al (1999) Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hepatobiliary Pancreat Surg 6:303–311

    Article  CAS  PubMed  Google Scholar 

  13. Janbain M, Leissinger CA, Kruse-Jarres R (2015) Acquired hemophilia A: emerging treatment options. J Blood Med 6:143–150

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Wada K, Takada T, Kawarada Y et al (2007) Diagnostic criteria and severity assessment of acute cholangitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14:52–58

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kiriyama S, Takada T, Strasberg SM et al (2012) New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines. J Hepatobiliary Pancreat Sci 19:548–556

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kimura W (2008) Strategies for the treatment of invasive ductal carcinoma of the pancreas and how to achieve zero mortality for pancreaticoduodenectomy. J Hepatobiliary Pancreat Surg 15:270–277

    Article  PubMed  Google Scholar 

  17. Friess H, Ho CK, Kleef J et al (2007) Pancreaticoduodenectomy, distal pancreatectomy, segmental pancreatectomy, total pancreatectomy, and transduodenal resection of the papilla of Vater. In: Surgery of the liver, biliary tract, and pancreas. Saunders, Philadelphia, pp 877–903

  18. Fujii T, Sugimoto H, Yamada S et al (2014) Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg 18:1108–1115

    Article  PubMed  Google Scholar 

  19. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  20. Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768

    Article  PubMed  Google Scholar 

  21. Wente MN, Bassi C, Dervenis C et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25

    Article  PubMed  Google Scholar 

  22. Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688

    Article  PubMed  Google Scholar 

  23. Westerkamp AC, Korkmaz KS, Bottema JT et al (2015) Elderly donor liver grafts are not associated with a higher incidence of biliary complications after liver transplantation: results of a national multicenter study. Clin Transplant 29:636–643

    Article  PubMed  Google Scholar 

  24. Higuchi R, Takada T, Strasberg SM et al (2013) TG13 miscellaneous etiology of cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 20:97–105

    Article  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. Chuang JH, Lee SY, Chen WJ et al (2001) Changes in bacterial concentration in the liver correlate with that in the hepaticojejunostomy after bile duct reconstruction: implication in the pathogenesis of postoperative cholangitis. World J Surg 25:1512–1518

    Article  CAS  PubMed  Google Scholar 

  27. Tsalis K, Antoniou N, Koukouritaki Z et al (2014) Successful treatment of recurrent cholangitis by constructing a hepaticojejunostomy with long Roux-en-Y limb in a long-term surviving patient after a Whipple procedure for pancreatic adenocarcinoma. Am J Case Rep 15:348–351

    Article  PubMed  PubMed Central  Google Scholar 

  28. Vrochides D, Fischer SA, Soares G et al (2007) Successful treatment of recurrent cholangitis complicating liver transplantation by Roux-en-Y limb lengthening. Transpl Infect Dis 9:327–331

    Article  CAS  PubMed  Google Scholar 

  29. Sanada Y, Yamada N, Taguchi M et al (2014) Recurrent cholangitis by biliary stasis due to non-obstructive afferent loop syndrome after pylorus-preserving pancreatoduodenectomy: report of a case. Int Surg 99:426–431

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bonnel DH, Fingerhut AL (2012) Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: long-term results in 110 patients. Am J Surg 203:675–683

    Article  PubMed  Google Scholar 

  31. Ammori BJ, Joseph S, Attia M et al (2000) Biliary strictures complicating pancreaticoduodenectomy. Int J Pancreatol 28:15–21 (discussion 21–22)

    Article  CAS  PubMed  Google Scholar 

  32. Sherman SC, Tran H (2006) Pneumobilia: benign or life-threatening. J Emerg Med 30:147–153

    Article  PubMed  Google Scholar 

  33. Mortelé KJ, Lemmerling M, de Hemptinne B et al (2000) Postoperative findings following the Whipple procedure: determination of prevalence and morphologic abdominal CT features. Eur Radiol 10:123–128

    Article  PubMed  Google Scholar 

  34. Gutknecht DR (2001) Cholangitis and pneumobilia after a Whipple procedure. Am J Emerg Med 19:87–88

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the radiologists and gastroenterologists at our hospital who greatly contributed to the clinical diagnosis and treatment of cholangitis in this study.

Author information

Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Hiroki Ueda, Daisuke Ban, Atsushi Kudo, Takanori Ochiai & Minoru Tanabe

  2. Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Shinji Tanaka

Authors
  1. Hiroki Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daisuke Ban
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atsushi Kudo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takanori Ochiai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shinji Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Minoru Tanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daisuke Ban.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Meeting presentation information: Presented as a poster presentation at the Society for Surgery of the Alimentary Tract poster session (Poster ID: Tu1504) in Digestive Disease Week 2016, May 24, 2016, San Diego, California, and at the 50th Annual Pancreas Club poster session (Poster ID: P073), May 20, 2016, San Diego, California.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ueda, H., Ban, D., Kudo, A. et al. Refractory Long-Term Cholangitis After Pancreaticoduodenectomy: A Retrospective Study. World J Surg 41, 1882–1889 (2017). https://doi.org/10.1007/s00268-017-3912-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-3912-z

Keywords

Search

Navigation