title: Incidence of hepaticojejunostomy stricture after hepaticojejunostomy.
abstract: Operations requiring biliary-enteric anastomosis are uncommon, and the true incidence of postoperative stricture is unknown. Our goal was to determine the timing, incidence, and management of stricture after biliary-enteric anastomosis.
  
  
  
  We used 5% Medicare claims data (1996-2011) to identify patients ≥66 years who underwent an operation requiring a biliary-enteric anastomosis. A cumulative incidence curve was used to describe timing of stricture diagnosis. The use of imaging and intervention was evaluated. A Cox proportional hazards model was constructed to identify factors associated with stricture.
  
  
  
  A total of 3,374 patients underwent an operation requiring either a hepaticojejunostomy (54.33%; N = 1,833) or choledochojejunostomy (45.67%; N = 1,541); 2-year survival was 57.0%. Overall, 403 (11.9%) patients developed a stricture. The cumulative incidence of stricture was 12.5% at 2 years. Mean time to stricture diagnosis was 16.8 ± 21.6 months (median = 8.5 months); 23% of patients with a stricture required hospitalization for cholangitis (N = 94). Only 18 (4.5%) patients with a stricture required reoperation. Younger age (hazard ratio 0.98; 95% confidence interval 0.98-0.99) was associated with a decreased likelihood of stricture formation; presence of an endostent (hazard ratio 1.66; 95% confidence interval 1.35-2.04) predicted stricture formation.
  
  
  
  Biliary-enteric anastomotic strictures occur with significant frequency after a biliary-enteric anastomosis. Although many patients are managed nonoperatively, stricture diagnosis remains burdensome.
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX; Department of Surgery, University of South Florida, Tampa, FL. Electronic address: frdimou@utmb.edu.
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Dimou
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX.
authors.forename: Deepak
authors.initials: D
authors.lastname: Adhikari
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX.
authors.forename: Hemalkumar B
authors.initials: HB
authors.lastname: Mehta
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX.
authors.forename: Kelly
authors.initials: K
authors.lastname: Olino
authors.affiliation: Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Brown
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000473:pathology / Q000601:surgery*; D002768:Choledochostomy / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D015994:Incidence; D007582:Jejunostomy / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology; D012086:Reoperation; D012189:Retrospective Studies