title: Early biliary complications following pancreaticoduodenectomy: prevalence and risk factors.
abstract: BACKGROUND
  Early biliary complications (EBC) following pancreaticoduodenectomy (PD) are poorly known. This study aimed to assess incidence, predictive factors, and treatment of EBC including bilio-enteric stricture, transient jaundice, biliary leak, and cholangitis.
  
  
  METHODS
  From 2007 to 2011, 352 patients underwent PD. Statistical analysis including logistic regression was performed to determine EBC predictive factors.
  
  
  RESULTS
  49 patients (14%) developed 51 EBC, including 7(2%) bilio-enteric strictures, 15(4%) transient jaundices, 9(3%) biliary leaks, and 20(6%) cholangitis with no mortality and a 18% reoperation rate. In multivariate analysis, male gender, benign disease, malignancy with preoperative chemoradiation, and common bile duct (CBD) diameter ≤ 5 mm were predictive of EBC. Of the 7 strictures, all were associated with CBD ≤ 5 mm and 5(71%) required reoperation. Transient jaundice resolved spontaneously in all 15 cases. Among 8 patients with serum bilirubin level > 50 μmol/L (3 mg/dL) at POD3, 7(88%) developed bilio-enteric stricture. Biliary leak resolved spontaneously in 5(56%); otherwise, it required reoperation. Cholangitis recurred after antibiotics discontinuation in 5(25%).
  
  
  CONCLUSIONS
  EBC following PD do not increase mortality. EBC are more frequent with male gender, benign disease, malignancy with preoperative chemoradiation, and CBD ≤ 5 mm. Transient jaundice or cholangitis has a favorable outcome, whereas bilio-enteric stricture or biliary leak can require reintervention.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Université Paris Diderot, Paris, France Clichy, 92110, France. Electronic address: bricemalgras@hotmail.com.
authors.forename: Brice
authors.initials: B
authors.lastname: Malgras
authors.affiliation: French Armed Forces Center for Epidemiology and Public Health, Marseille, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Duron
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Université Paris Diderot, Paris, France Clichy, 92110, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gaujoux
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Université Paris Diderot, Paris, France Clichy, 92110, France.
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Université Paris Diderot, Paris, France Clichy, 92110, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Aussilhou
authors.affiliation: Departement of Pancreatology, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Université Paris Diderot, Paris, France Clichy, 92110, France.
authors.forename: Vinciane
authors.initials: V
authors.lastname: Rebours
authors.affiliation: Departement of Pancreatology, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Université Paris Diderot, Paris, France Clichy, 92110, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Palazzo
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Université Paris Diderot, Paris, France Clichy, 92110, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Université Paris Diderot, Paris, France Clichy, 92110, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D002761:Cholangitis / Q000453:epidemiology; D002779:Cholestasis / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D041781:Jaundice, Obstructive / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D010297:Paris / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents