title: Post-operative depletion of platelet count is associated with anastomotic insufficiency following intrahepatic cholangiojejunostomy: a case-control study from the results of 220 cases of intrahepatic cholangiojejunostomy.
abstract: BACKGROUND
  Post-operative anastomotic insufficiency following major hepato-biliary surgery has significant impacts on the post-operative course. Recent reports have revealed that platelets play an important role in liver regeneration and wound healing. From these experimental and clinical results on platelet function, we hypothesized that post-operative platelet depletion (to <10 × 104/μL) would be associated with delayed liver regeneration as well as anastomotic insufficiency of intrahepatic cholangiojejunostomy. However, little information is available regarding correlations between platelet count and these complications. The purposes of the present study were, firstly, to evaluate the incidence of anastomotic insufficiency following intrahepatic cholangiojejunostomy and, secondly, to evaluate whether platelet depletion represents a risk factor for anastomotic insufficiency in intrahepatic cholangiojejunostomy.
  
  
  METHODS
  Participants in this study comprised 220 consecutive patients who underwent intrahepatic cholangiojejunostomy following hepato-biliary resection for biliary malignancies between September 1998 and December 2010. Anastomotic insufficiency was confirmed by cholangiographic demonstration of leakage from the anastomosis using contrast medium introduced via a biliary drainage tube or prophylactic drain placed during surgery.
  
  
  RESULTS
  Anastomotic insufficiency of the intrahepatic cholangiojejunostomy occurred in 13 of 220 patients (6%). Thirteen of the 220 patients, including one with anastomotic insufficiency, died during the study. Uni- and multivariate analyses both revealed that platelet depletion on post-operative day 1 (<10 × 104/μL) correlated with anastomotic insufficiency.
  
  
  CONCLUSIONS
  Post-operative platelet depletion was closely associated with anastomotic insufficiency following intrahepatic cholangiojejunostomy. This correlation has been established, but the underlying mechanisms have not.
authors.affiliation: Department of Gastroenterological Surgery II, Graduate School of Medicine, Hokkaido University, N15W7, Kita-ku, Sapporo Hokkaido 060-8638, Japan. drnoji@med.hokudai.ac.jp.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Noji
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.forename: Yuma
authors.initials: Y
authors.lastname: Ebihara
authors.forename: Toru
authors.initials: T
authors.lastname: Nakamura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kato
authors.forename: Joe
authors.initials: J
authors.lastname: Matsumoto
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shichinohe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000097:blood*; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011184:Postoperative Period; D012189:Retrospective Studies; D014463:Ultrasonography