title: Technical procedures causing biliary complications after hepaticojejunostomy in pancreaticoduodenectomy.
abstract: BACKGROUND
  Although pancreaticoduodenectomy has been established as a standard operation for pancreatobiliary diseases, postoperative biliary complications still exist and impair patient quality of life.
  
  
  METHODS
  We enrolled 67 patients who underwent pancreaticoduodenectomy. Patients were divided into 2 chronological groups representing different surgical procedures: group A (G-A) included patients treated between 2003 and 2006 and group B (G-B) included patients treated later. We compared surgical procedures and postoperative biliary complications between the groups.
  
  
  RESULTS
  The number of stitches at hepaticojejunostomy was 33.2 ± 8.4 in G-A and 14.0 ± 2.3 in G-B. A biliary drainage stent was placed in 31 of 32 cases in G-A and in none of the 35 cases in G-B. For each surgical procedure, there was a significant difference between the groups. Bile leakage occurred in 9.4% of G-A patients and 2.9% of G-B patients. The serum alkaline phosphatase level was significantly higher in G-A than in G-B. Moreover, the number of patients hospitalized for cholangitis was significantly greater in G-A than in G-B.
  
  
  CONCLUSIONS
  Among procedure-related factors pertaining to hepaticojejunostomy in pancreaticoduodenectomy, the number of anastomotic stitches and the placement of a biliary drainage stent were confirmed to affect the development of an anastomotic stricture.
authors.forename: Takashi
authors.initials: T
authors.lastname: Orii
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Karasawa
authors.forename: Hiroe
authors.initials: H
authors.lastname: Kitahara
authors.forename: Masaki
authors.initials: M
authors.lastname: Yoshimura
authors.forename: Motohiro
authors.initials: M
authors.lastname: Okumura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002761:Cholangitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D010359:Patient Readmission; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome