Infectious complications after liver resection in patients with prior biliary-enteric anastomosis: a multicenter
Hayata Sano1, Takeshi Urade1, Atsushi Takebe2
1Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan.
Background:
Liver resection in patients with prior biliary-enteric anastomosis (BEA) is associated with high rates of infectious complications. We evaluated the incidence, patterns, and risk factors.
Methods:
This multicenter retrospective study included patients with prior BEA who underwent liver resection at three Japanese institutions between 2008 and 2025. The primary endpoint was organ/space surgical site infection (SSI) within 30 days postoperatively. Univariable analyses were performed to identify factors associated with organ/space SSI, comparing patients with and without this complication.
Results:
Among the 26 patients, pancreatoduodenectomy was the most common preceding BEA procedure. Organ/space SSI occurred in 10 patients, and overall infectious complications occurred in 13 patients, including 3 with other infections. Cultures were positive in 6 of 10 organ/space SSI cases, and all isolates were enteric organisms. Organ/space SSI occurred more frequently with concave-type than flat-type transection surface morphology (8 of 13 vs. 2 of 13; P = 0.041). Organ/space SSI was associated with significantly prolonged postoperative hospital stay (median [range], 28.5 [13-94] vs. 13 [6-105] days; P = 0.003).
Conclusion:
Liver resection after BEA carries a substantial risk of postoperative organ/space SSI. Concave transection surface morphology may represent a clinically relevant risk factor in this high-risk population.