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Incidence and Risk Factors of Cholangitis after Hepaticojejunostomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  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.

    Article  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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Acknowledgments

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.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan

    Takehiro Okabayashi, Yasuo Shima, Tatsuaki Sumiyoshi & Kenta Sui

  2. Department of Diagnostic Pathology, Kochi Health Sciences Center, Kochi, Japan

    Jun Iwata

  3. Department of Radiology, Kochi Health Sciences Center, Kochi, Japan

    Sojiro Morita

  4. Department of Biostatistics, Kochi Medical School, Kochi, Japan

    Tatsuo Iiyama

  5. Department of Clinical Oncology, Kochi Medical School, Kochi, Japan

    Yasuhiro Shimada

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  1. Takehiro Okabayashi
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  2. Yasuo Shima
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  3. Tatsuaki Sumiyoshi
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  4. Kenta Sui
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  5. Jun Iwata
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  8. Yasuhiro Shimada
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Correspondence to Takehiro Okabayashi.

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Okabayashi, T., Shima, Y., Sumiyoshi, T. et al. Incidence and Risk Factors of Cholangitis after Hepaticojejunostomy. J Gastrointest Surg 22, 676–683 (2018). https://doi.org/10.1007/s11605-017-3532-9

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  • DOI: https://doi.org/10.1007/s11605-017-3532-9

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