title: The difficult hepaticojejunostomy after pancreatic head resection: reconstruction with a T tube.
abstract: BACKGROUND
  After pancreatic head resection, bile leaks from a difficult hepaticojejunostomy secondary to a small or fragile common hepatic duct may be reduced by a T tube at the side of the anastomosis.
  
  
  METHODS
  A retrospective analysis of patients who underwent a difficult hepaticojejunostomy without or with a T tube was performed.
  
  
  RESULTS
  In 48% (55/114) of patients, a T tube was placed at the side of the hepaticojejunostomy; 52% (59/114) did not have a T tube. Bile leaks occurred in 12% (14/114) (9% [5/55] in patients with a T tube vs 15% [9/59] without a T tube, P = .316). Bile leaks were associated with mortality, abscess formation, hemorrhage, and sepsis. Seven percent (8/114) of patients required revisional laparotomy (2% [1/55] with a T tube vs 12% [7/59] without a T tube, P = .036). Mortality was not different between the groups. Minor T-tube-associated complications occurred in 15% (8/55) without major complications.
  
  
  CONCLUSIONS
  Augmentation of anastomosis with a T tube cannot prevent biliary leakage but does reduce the severity of bile leaks, resulting in less reoperations.
authors.affiliation: Department of Surgery, St. Josef Hospital Bochum, University Hospital, Gudrunstr. 56, D-44791 Bochum, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Herzog
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.forename: Philipp
authors.initials: P
authors.lastname: Bakowski
authors.forename: Ansgar M
authors.initials: AM
authors.lastname: Chromik
authors.forename: Monika
authors.initials: M
authors.lastname: Janot
authors.forename: Dominique
authors.initials: D
authors.lastname: Suelberg
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.forename: Matthias H
authors.initials: MH
authors.lastname: Seelig
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D057868:Anastomotic Leak / Q000517:prevention & control*; D001646:Bile; D015331:Cohort Studies; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D007582:Jejunostomy / Q000379:methods* / Q000401:mortality; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000209:etiology; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D012086:Reoperation; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology
keywords: Bile leak; Hepaticojejunostomy; Pancreatic surgery; T tube