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Published on: May 5, 2023
Biliary leakage following pancreaticoduodenectomy: Prevalence, risk factors and management
Ayman El Nakeeb1, Mohamed El Sorogy1, Hosam Hamed1
1Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
Insights
Biliary leakage after pancreaticoduodenectomy (PD) occurs in 7.9% of cases, with obesity and longer reconstruction time as risk factors. Most cases can be managed non-surgically, but leakage increases morbidity and mortality risks.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Biliary leakage post-pancreaticoduodenectomy (PD) is less studied than postoperative pancreatic fistula (POPF).
- Understanding biliary leakage incidence, risk factors, and management is crucial for patient outcomes.
Purpose of the Study:
- To determine the incidence of biliary leakage after PD.
- To identify predisposing factors for biliary leakage.
- To evaluate the management strategies for biliary leakage.
Main Methods:
- Retrospective study of 555 patients undergoing PD from 2008-2017.
- Patients divided into groups based on the presence or absence of biliary leakage.
- Analysis of preoperative, operative, and postoperative data, including morbidity and mortality.
Main Results:
- Biliary leakage occurred in 7.9% of patients; 1.8% had concomitant POPF.
- Obesity and longer hepaticojejunostomy reconstruction time were independent risk factors; no prior ERCP was protective.
- Biliary leakage significantly increased delayed gastric emptying, wound infection, hospital stay, and mortality.
Conclusions:
- Obesity and prolonged hepaticojejunostomy reconstruction time are key risk factors for biliary leakage post-PD.
- Absence of preoperative ERCP is a protective factor against biliary leakage.
- While often manageable conservatively, biliary leakage elevates morbidity and mortality risks, especially with concurrent POPF.
Background:
Few studies investigated biliary leakage after pancreaticoduodenectomy (PD) especially when compared to postoperative pancreatic fistula (POPF). This study was to determine the incidence of biliary leakage after PD, predisposing factors of biliary leakage, and its management.
Methods:
We retrospectively studied all patients who underwent PD from January 2008 to December 2017 at Gastrointestinal Surgery Center, Mansoura University, Egypt. According to occurrence of postoperative biliary leakage, patients were divided into two groups. Group (1) included patients who developed biliary leakage and group (2) included patients without identified biliary leakage. The preoperative data, operative details, and postoperative morbidity and mortality were analyzed.
Results:
The study included 555 patients. Forty-four patients (7.9%) developed biliary leakage. Ten patients (1.8%) had concomitant POPF. Multivariate analysis identified obesity and time needed for hepaticojejunostomy reconstruction as independent risk factors of biliary leakage, and no history of preoperative endoscopic retrograde cholangiopancreatiography (ERCP) as protective factor. Biliary leakage from hepaticojejunostomy after PD leads to a significant increase in development of delayed gastric emptying, and wound infection. The median hospital stay and time to resume oral intake were significantly greater in the biliary leakage group. Non-surgical management was needed in 40 patients (90.9%). Only 4 patients (9.1%) required re-exploration due to biliary peritonitis and associated POPF. The mortality rate in the biliary leakage group was significantly higher than that of the non-biliary leakage group (6.8% vs 3.9%, P = 0.05).
Conclusions:
Obesity and time needed for hepaticojejunostomy reconstruction are independent risk factors of biliary leakage, and no history of preoperative ERCP is protective factor. Biliary leakage increases the risk of morbidity and mortality especially if concomitant with POPF. However, biliary leakage can be conservatively managed in majority of cases.
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