Late postoperative complications in patients with pancreaticobiliary maljunction.
OBJECTIVE
Reports on the late postoperative complications in patients with pancreaticobiliary maljunction (PBM) are limited.


METHODS
Eighteen PBM patients with biliary dilatation and 12 without biliary dilatation were surgically treated at our institute. These 30 PBM patients were retrospectively reviewed, with particular attention to late postoperative complications.


RESULTS
Nineteen patients without biliary malignancies underwent resection of the extrahepatic bile duct (BD) and hepaticojejunostomy. Two patients without biliary dilatation or malignancy underwent cholecystectomy alone. Nine patients with malignancies underwent hepatectomy with extrahepatic BD resection in 7 patients, pancreatoduodenectomy (PD) in 1, and PD + hepatectomy in 1. The median follow-up duration was 110 months. All patients without malignancies are presently alive in good healthy condition and have not developed any malignancy postoperatively. Late postoperative complications were seen in 6 (20%). Four patients with biliary dilatation were surgically or endoscopically treated for intrahepatic lithiasis 3, 12, 42 and 54 months after initial operation. One of them had a pancreatic protein plug 216 months after surgery, and was treated with papilloplasty after open laparotomy. In one patient without biliary dilatation, pancreatic protein plug and intrahepatic lithiasis were found 60 and 72 months after surgery, respectively, and both were treated endoscopically.


CONCLUSIONS
Intrahepatic lithiasis and pancreatic protein plug are frequent late postoperative complications. The intrapancreatic residual choledochus or dilated pancreatic duct seems to be related to pancreatic protein plug. However, intrahepatic lithiasis may occur regardless of the pattern of the biliary tract dilatation. Careful, long-term follow-up is important in patients with PBM.
Sakaguchi
Takanori
T
Second Department of Surgery, Hamamatsu University School of Medicine, Japan. saka1119@hama-med.ac.jp
Suzuki
Shohachi
S
Suzuki
Atsushi
A
Fukumoto
Kazuhiko
K
Jindo
Osamu
O
Ota
Shigeyasu
S
Inaba
Keisuke
K
Kikuyama
Masataka
M
Nakamura
Satoshi
S
Konno
Hiroyuki
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D017734:Bile Ducts, Extrahepatic / Q000002:abnormalities* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000002:abnormalities* / Q000601:surgery; D001661:Biliary Tract Neoplasms / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D002779:Cholestasis / Q000209:etiology / Q000601:surgery; D004108:Dilatation, Pathologic / Q000151:congenital / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies