Related Experiment Video
Updated: Jun 17, 2025
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Celiac Axis Stenosis as an Independent Risk Factor for Bile Leakage in Laparoscopic Pancreaticoduodenectomy: A
Yu Fu1, Shupeng Wang1, Ludong Tan1
1Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China.
Insights
Severe celiac axis stenosis increases bile leakage risk after laparoscopic pancreaticoduodenectomy (LPD). This finding highlights the importance of assessing celiac trunk stenosis before LPD to mitigate surgical complications.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Surgical Oncology
Background:
- Celiac axis stenosis can compromise blood flow to vital organs.
- Collateral circulation, often present in stenosis, may be disrupted during pancreaticoduodenectomy (PD).
- Disruption of collateral circulation can elevate the risk of postoperative complications.
Purpose of the Study:
- To investigate the impact of celiac axis stenosis on postoperative complications following laparoscopic pancreaticoduodenectomy (LPD).
- To identify independent risk factors for bile leakage after LPD, with a focus on celiac axis stenosis.
Main Methods:
- Retrospective analysis of 997 patients undergoing LPD between April 2015 and April 2023.
- Classification of celiac trunk stenosis into no stenosis, grade A (30%-<50%), grade B (50%-≤80%), and grade C (>80%).
- Univariate and multivariate analyses were performed to evaluate the incidence of postoperative complications, including bile leakage and pancreatic fistula.
Main Results:
- 2.3% of patients had mild, 1.8% moderate, and 1.0% severe celiac axis stenosis.
- Independent risk factors for bile leakage included higher BMI, intra-abdominal infection, postoperative hemorrhage, and severe celiac axis stenosis (grades B and C).
- Celiac axis stenosis was not an independent risk factor for pancreatic fistula; aberrant hepatic artery presence did not significantly increase complications.
Conclusions:
- Severe celiac axis stenosis (≥50%) is an independent risk factor for postoperative bile leakage after LPD.
- Preoperative assessment of celiac axis stenosis is crucial for risk stratification and management in patients undergoing LPD.
Abstract:
Celiac axis stenosis can potentially lead to insufficient blood supply to vital organs, such as the liver, spleen, pancreas, and stomach. This condition result in the development of collateral circulation between the superior mesenteric artery and the hepatic artery. However, these collateral circulations are often disrupted during pancreaticoduodenectomy (PD), which may increase the risk of postoperative complications. A retrospective analysis was conducted on patients who underwent laparoscopic pancreaticoduodenectomy (LPD) from April 2015 to April 2023. Celiac trunk stenosis is classified according to the degree of stenosis: no stenosis (<30%), grade A (30%-<50%), grade B (50%-≤80%), and grade C (>80%). The incidence of postoperative complications was evaluated, and both univariate and multivariate risk analyses were conducted. A total of 997 patients were included in the study, with mild celiac axis stenosis present in 23 (2.3%) patients, moderate stenosis in 18 (1.8%) patients, and severe stenosis in 10 (1.0%) patients. Independent risk factors for the development of bile leakage, as identified by both univariate and multivariate analyses, included body mass index (BMI) (HR = 1.108, 95% CI = 1.008-1.218, P = .033), intra-abdominal infection (HR = 2.607, 95% CI = 1.308-5.196, P = .006), postoperative hemorrhage (HR = 4.510, 95% CI = 2.048-9.930, P = <0.001), and celiac axis stenosis (50%-≤80%, HR = 4.235, 95% CI = 1.153-15.558, P = .030), and (>80%, HR = 4.728, 95% CI = .882-25.341, P = .047). Celiac axis stenosis, however, was not determined to be an independent risk factor for pancreatic fistula (P > 0.05). Additionally, the presence of an aberrant hepatic artery did not significantly increase the risk of postoperative complications when compared with celiac axis stenosis alone. Severe celiac axis stenosis is an independent risk factor for postoperative bile leakage following LPD.
