Late benign biliary complications after pancreatoduodenectomy

Pancreatoduodenectomy sometimes causes late benign biliary complications, such as biliary stricture and/or hepaticolithiasis, which require intervention. The risk factors and timing of late biliary complications remain unclear. The purpose of this study was to clarify the incidence, timing of occurrence, and risk factors for late biliary complications after pancreatoduodenectomy.

A total of 732 patients who underwent pancreatoduodenectomy between 2002 and 2016 were included in this retrospective study. Postoperative late biliary complications were defined as symptomatic benign biliary stricture and hepaticolithiasis, requiring radiologic or endoscopic intervention. Perioperative variables were collected to analyze the risk factors for late biliary complications. The treatment of late biliary complications was then evaluated.

A total of 28 patients (3.8%) developed late biliary complications with a median interval of 23.4 (0.7-98.9) months. Late biliary complications consisted of hepaticolithiasis (n = 11) and stricture (n = 27) (including overlap). The 5-year cumulative incidence of late biliary complications was 7.3%. A multivariate analysis showed that a common hepatic duct diameter of < 4 mm was an independent risk factor for late biliary complications. The 5-year cumulative incidence of late biliary complications in patients with a common hepatic duct diameter of < 4 mm was significantly higher than that of patients with a common hepatic duct diameter of ≥ 4 mm (27.6% vs 1.3%, P < .001). For initial treatment, endoscopic intervention (balloon dilation, lithotomy, and stenting) was successfully performed in 21 patients (75.0%), and percutaneous transhepatic intervention was performed in 7 (25.0%). No patients underwent surgery.

The occurrence of late biliary complications was associated with a common hepatic duct diameter of < 4 mm. At the end of follow-up, high-risk patients should be adequately informed about late biliary complications and their symptoms.