title: Hepaticoplasty prevents cholangitis after pancreaticoduodenectomy in patients with small bile ducts.
abstract: BACKGROUND
  To reduce cholangitis after pancreaticoduodenectomy (PD), we perform 'hepaticoplasty', in which the left side of the bile duct is cut to widen the diameter of the bile duct wall before hepaticojejunostomy. The aim of this study was to clarify the usefulness of hepaticoplasty to reduce cholangitis after PD.
  
  
  METHODS
  From January 2002 through December 2010, 161 patients underwent PD and were enrolled in this study. Patient demographics, surgical factors, and clinical and biochemical parameters were evaluated to examine the factors predictive of cholangitis after PD and confirm the usefulness of hepaticoplasty.
  
  
  RESULTS
  Cholangitis after PD occurred in 13 patients (8.1%). Multivariate analysis revealed that the ratio of the postoperative bile duct diameter to that before surgery was the only independent risk factor for cholangitis after PD (p = 0.0012). In the small bile duct group, in which the diameter was ≤15 mm before surgery (n = 99), hepaticoplasty reduced the narrowing of the bile duct after PD, and no cholangitis occurred. There were no complications related to hepaticoplasty.
  
  
  CONCLUSIONS
  The ratio of postoperative reduction of the bile duct diameter to that before surgery was found to be the only risk factor for cholangitis after PD. Patients with a small bile duct of ≤15 mm in diameter preoperatively might benefit from hepaticoplasty to widen the bile duct diameter and prevent cholangitis after PD.
authors: University of Miyazaki, Faculty of Medicine, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Miyazaki, Japan. Electronic address: mhiyoshi@med.miyazaki-u.ac.jp.
authors: Masahide
authors: M
authors: Hiyoshi
authors: University of Miyazaki, Faculty of Medicine, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Miyazaki, Japan.
authors: Takashi
authors: T
authors: Wada
authors: University of Miyazaki, Faculty of Medicine, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Miyazaki, Japan.
authors: Yuki
authors: Y
authors: Tsuchimochi
authors: University of Miyazaki, Faculty of Medicine, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Miyazaki, Japan.
authors: Takeomi
authors: T
authors: Hamada
authors: University of Miyazaki, Faculty of Medicine, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Miyazaki, Japan.
authors: Koichi
authors: K
authors: Yano
authors: University of Miyazaki, Faculty of Medicine, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Miyazaki, Japan.
authors: Naoya
authors: N
authors: Imamura
authors: University of Miyazaki, Faculty of Medicine, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Miyazaki, Japan.
authors: Yoshiro
authors: Y
authors: Fujii
authors: University of Miyazaki, Faculty of Medicine, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Miyazaki, Japan.
authors: Atsushi
authors: A
authors: Nanashima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002761:Cholangitis / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012307:Risk Factors
keywords: Cholangitis; Hepaticoplasty; Pancreaticoduodenectomy