title: Complications of biliary-enteric anastomoses.
abstract: INTRODUCTION Biliary-enteric anastomoses are performed for a range of indications and may result in early and late complications. The aim of this study was to assess the risk factors and management of anastomotic leak and stricture following biliary-enteric anastomosis. METHODS A retrospective analysis of the medical records of patients who underwent biliary-enteric anastomoses in a tertiary referral centre between 2000 and 2010 was performed. RESULTS Four hundred and sixty-two biliary-enteric anastomoses were performed. Of these, 347 (75%) were performed for malignant disease. Roux-en-Y hepaticojejunostomy or choledocho-jejunostomy were performed in 440 (95%) patients. Perioperative 30-day mortality was 6.5% (n=30). Seventeen patients had early bile leaks (3.7%) and 17 had late strictures (3.7%) at a median of 12 months. On univariable logistic regression analysis, younger age was a significant risk factor for biliary anastomotic leak. However, on multivariable analysis only biliary reconstruction following biliary injury (odds ratio [OR]=6.84; p=0.002) and anastomosis above the biliary confluence (OR=4.62; p=0.03) were significant. Younger age and biliary reconstruction following injury appeared to be significant risk factors for biliary strictures but multivariable analysis showed that only younger age was significant. CONCLUSIONS Biliary-enteric anastomoses have a low incidence of early and late complications. Biliary reconstruction following injury and a high anastomosis (above the confluence) are significant risk factors for anastomotic leak. Younger patients are significantly more likely to develop an anastomotic stricture over the longer term.
authors.affiliation: The Royal London Hospital, Barts Health NHS Trust , London , UK.|Queen Mary University of London , London , UK.
authors.forename: R S
authors.initials: RS
authors.lastname: Kadaba
authors.affiliation: The Royal London Hospital, Barts Health NHS Trust , London , UK.
authors.forename: K A
authors.initials: KA
authors.lastname: Bowers
authors.affiliation: The Royal London Hospital, Barts Health NHS Trust , London , UK.
authors.forename: S
authors.initials: S
authors.lastname: Khorsandi
authors.affiliation: The Royal London Hospital, Barts Health NHS Trust , London , UK.
authors.forename: R R
authors.initials: RR
authors.lastname: Hutchins
authors.affiliation: The Royal London Hospital, Barts Health NHS Trust , London , UK.
authors.forename: A T
authors.initials: AT
authors.lastname: Abraham
authors.affiliation: Queen Mary University of London , London , UK.
authors.forename: S-J
authors.initials: SJ
authors.lastname: Sarker
authors.affiliation: The Royal London Hospital, Barts Health NHS Trust , London , UK.
authors.forename: S
authors.initials: S
authors.lastname: Bhattacharya
authors.affiliation: The Royal London Hospital, Barts Health NHS Trust , London , UK.|Queen Mary University of London , London , UK.
authors.forename: H M
authors.initials: HM
authors.lastname: Kocher
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000453:epidemiology; D001649:Bile Duct Diseases / Q000453:epidemiology*; D001650:Bile Duct Neoplasms / Q000601:surgery; D001652:Bile Ducts / Q000293:injuries; D001662:Biliary Tract Surgical Procedures; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D002768:Choledochostomy; D003135:Common Bile Duct / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D003251:Constriction, Pathologic / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D007582:Jejunostomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Fistula; Leak; Stricture