title: Incidence and risk factors for anastomotic stenosis of continuous hepaticojejunostomy after pancreaticoduodenectomy.
abstract: BACKGROUND
  There have been no reports showing the incidence of anastomotic stenosis of continuous hepaticojejunostomy (HJ) and identifying its risk factors for patients who underwent pancreaticoduodenectomy (PD).
  
  
  METHODS
  We retrospectively investigated 200 patients whose HJ was established by unified method, single layered continuous suture. HJ stenosis was diagnosed with endoscopic or radiologic examinations. Uni and multivariable unconditional logistic modeling were performed to explore the predictive factors and to estimate odds ratios (ORs) and their 95% confidence intervals (CIs).
  
  
  RESULTS
  Sixteen patients (8.0%) were diagnosed as HJ stenosis. Multivariable analysis showed that body mass index (BMI) (OR: 1.24; 95% CI: 1.03-1.51), absence of preoperative biliary stenting (OR: 11.10; 95% CI: 1.22-101.12), operative time (OR: 1.74 per one hour increase; 95% CI: 1.01-2.98), age (OR: 1.58 per 10 years increase; 95% CI: 0.88-2.85), and absence of nodal metastasis (OR: 3.43; 95% CI: 0.90-13.12) correlated with HJ stenosis. Among these, BMI and preoperative biliary stenting were associated with stenosis with a lower P-value than the others (P = 0.026 and 0.033, respectively).
  
  
  CONCLUSIONS
  The incidence of HJ stenosis was 8.0%. Close attention would be needed especially for patients at high risk of HJ stenosis, such as high BMI or absence of preoperative biliary stenting.
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.|Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Tomonari
authors.initials: T
authors.lastname: Asano
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan. seijinn@hotmail.com.
authors.forename: Seiji
authors.initials: S
authors.lastname: Natsume
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Senda
authors.affiliation: Department of Gastroenterological Surgery, Aichi Medical University Hospital, Nagakute, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sano
authors.affiliation: Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Ito
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012372:ROC Curve; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Anastomotic stenosis; Continuous hepaticojejunostomy; Pancreaticoduodenectomy