Journal of Gastrointestinal Surgery

, Volume 22, Issue 4, pp 676–683 | Cite as

Incidence and Risk Factors of Cholangitis after Hepaticojejunostomy

  • Takehiro Okabayashi
  • Yasuo Shima
  • Tatsuaki Sumiyoshi
  • Kenta Sui
  • Jun Iwata
  • Sojiro Morita
  • Tatsuo Iiyama
  • Yasuhiro Shimada
Original Article



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.


Hepaticojejunosotomy 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.


  1. 1.
    Cattel RB, Braasch JW. General consideration in the management of benign strictures of the bile duct. N Engl J Med 1959; 261:929–933.CrossRefGoogle Scholar
  2. 2.
    Csendes A, Diaz C, Burdiles P, Nava O, Yarmuch J, Maluenda F, Fernandez E. Indications and results of hepaticojejunostomy in benign strictures of the biliary tract. Hepatogastroenterology 1992; 39:333–336.PubMedGoogle Scholar
  3. 3.
    Hiyoshi M, Wada T, Tsuchimochi Y, Hamada T, Yano K, Imamura N, Fujii Y, Nanashima A. Hepaticoplasty prevents cholangitis after pancreaticoduodenectomy in patients with small bile ducts. Int J Surg. 2016;35:7–12.CrossRefPubMedGoogle Scholar
  4. 4.
    Röthlin MA, Löpfe M, Schlumpf R, Largiadèr F. Long-term results of hepaticojejunostomy for benign lesions of the bile ducts. Am J Surg. 1998;175:22–26.CrossRefPubMedGoogle Scholar
  5. 5.
    Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan AC, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG; Tokyo Guidelines Revision Committee. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20:35–46.CrossRefPubMedGoogle Scholar
  6. 6.
    Kiriyama S, Takada T, Hwang TL, Akazawa K, Miura F, Gomi H, Mori R, Endo I, Itoi T, Yokoe M, Chen MF, Jan YY, Ker CG, Wang HP, Yamaue H, Miyazaki M, Yamamoto M. Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: An international multicenter observational study. J Hepatobiliary Pancreat Sci. 2017;24:329–337.CrossRefPubMedGoogle Scholar
  7. 7.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.CrossRefPubMedGoogle Scholar
  8. 8.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Pottakkat B, Vijayahari R, Prakash A, Singh RK, Behari A, Kumar A, Kapoor VK, Saxena R. Incidence, pattern and management of bile duct injuries during cholecystectomy: experience from a single center. Dig Surg. 2010;27:375–379.CrossRefPubMedGoogle Scholar
  10. 10.
    Tocchi A, Costa G, Lepre L, Liotta G, Mazzoni G, Sita A. The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures. Ann Surg. 1996;224:162–167.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Orii T, Karasawa Y, Kitahara H, Yoshimura M, Okumura M. Technical procedures causing biliary complications after hepaticojejunostomy in pancreaticoduodenectomy. Hepatogastroenterology. 2014;61:1857–1862.PubMedGoogle Scholar
  12. 12.
    Grobmyer SR, Hollenbeck ST, Jaques DP, Jarnagin WR, DeMatteo R, Coit DG, Blumgart LH, Brennan MF, Fong Y. Roux-en-Y reconstruction after pancreaticoduodenectomy. Arch Surg. 2008;143:1184–1188.CrossRefPubMedGoogle Scholar
  13. 13.
    Suzuki Y, Fujino Y, Tanioka Y, Ajiki T, Hiraoka K, Takada M, Takeyama Y, Tominaga M, Ku Y, Kuroda Y. Factors influencing hepaticojejunostomy leak following pancreaticoduodenal resection; importance of anastomotic leak test. Hepatogastroenterology. 2003;50:254–257.PubMedGoogle Scholar
  14. 14.
    Felder SI, Menon VG, Nissen NN, Margulies DR, Lo S, Colquhoun SD. Hepaticojejunostomy using short-limb Roux-en-Y reconstruction. JAMA Surg. 2013;148:253–257.CrossRefPubMedGoogle Scholar
  15. 15.
    House MG, Cameron JL, Schulick RD, Campbell KA, Sauter PK, Coleman J, Lillemoe KD, Yeo CJ. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg. 2006;243:571–576.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Reid-Lombardo KM, Ramos-De la Medina A, Thomsen K, Harmsen WS, Farnell MB. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg. 2007;11:1704–1711.CrossRefPubMedGoogle Scholar
  17. 17.
    Kim JH, Choi TY, Han JH, Yoo BM, Kim JH, Hong J, Kim MW, Kim WH. Risk factors of postoperative anastomotic stricture after excision of choledochal cysts with hepaticojejunostomy. J Gastrointest Surg. 2008;12:822–828.CrossRefPubMedGoogle Scholar
  18. 18.
    Kucukay F, Okten RS, Yurdakul M, Ozdemir E, Erat S, Parlak E, Disibeyaz S, Ozer I, Bostanci EB, Olcer T, Tola M. Long-term results of percutaneous biliary balloon dilation treatment for benign hepaticojejunostomy strictures: are repeated balloon dilations necessary? J Vasc Interv Radiol. 2012;23:1347–1355.CrossRefPubMedGoogle Scholar
  19. 19.
    Parlak E, Ciçek B, Dişibeyaz S, Cengiz C, Yurdakul M, Akdoğan M, Kiliç MZ, Saşmaz N, Cumhur T, Sahin B. Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy. Surg Endosc. 2010;24:466–470.CrossRefPubMedGoogle Scholar
  20. 20.
    Prawdzik C, Belyaev O, Chromik AM, Uhl W, Herzog T. Surgical revision of hepaticojejunostomy strictures after pancreatectomy. Langenbecks Arch Surg. 2015;400:67–75.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Takehiro Okabayashi
    • 1
  • Yasuo Shima
    • 1
  • Tatsuaki Sumiyoshi
    • 1
  • Kenta Sui
    • 1
  • Jun Iwata
    • 2
  • Sojiro Morita
    • 3
  • Tatsuo Iiyama
    • 4
  • Yasuhiro Shimada
    • 5
  1. 1.Department of Gastroenterological SurgeryKochi Health Sciences CenterKochi-CityJapan
  2. 2.Department of Diagnostic PathologyKochi Health Sciences CenterKochiJapan
  3. 3.Department of RadiologyKochi Health Sciences CenterKochiJapan
  4. 4.Department of BiostatisticsKochi Medical SchoolKochiJapan
  5. 5.Department of Clinical OncologyKochi Medical SchoolKochiJapan

Personalised recommendations