The Impact of Hepaticojejunostomy Leaks After Pancreatoduodenectomy: a Devastating Source of Morbidity and Mortality.
Hepaticojejunostomy leaks are less frequent than pancreatic leaks after pancreatoduodenectomy, and the current literature suggests comparable outcomes. The purpose of this study was to determine if the hepaticojejunostomy leak adversely affected patient outcomes.



Consecutive cases of pancreatoduodenectomy (n = 924) were reviewed at a single high-volume institution over an 8-year period (2006-2014).



Pancreaticojejunostomy leaks were identified in 217 (23%) patients and hepaticojejunostomy leaks were identified in 24 patients (3%); combined hepaticojejunostomy/pancreaticojejunostomy leaks were identified in 31 patients (3%). Those with hepaticojejunostomy leaks or combined leaks had a significantly increased risk of morbidity when compared to pancreaticojejunostomy leaks or no leak (54 and 58 vs. 34 and 24%, respectively, p < 0.05). The median length of stay was significantly greater for hepaticojejunostomy leaks or combined leaks when compared to pancreatojejunostomy leaks (17 or 14 vs. 9 days, p = 0.001) and those with no leak (17 or 14 vs. 7 days, p = 0.001). Ninety-day mortality for all patients was 3.6%. Hepaticojejunostomy leaks and combined leaks significantly increased 90-day mortality rate (17 and 32%, respectively, p < 0.05).



Hepaticojejunostomy and combined leaks after pancreatoduodenectomy are rarer than pancreaticojejunostomy leaks; these patients are at a significantly increased risk of major morbidity and mortality.
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA.
Andrea L
AL
Jester
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA.
Catherine W
CW
Chung
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA.
David C
DC
Becerra
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA.
E
E
Molly Kilbane
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA.
Michael G
MG
House
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA.
Nicholas J
NJ
Zyromski
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA.
C
C
Max Schmidt
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA.
Attila
A
Nakeeb
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA. eceppa@iupui.edu.
Eugene P
EP
Ceppa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology* / Q000401:mortality; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D010193:Pancreaticojejunostomy / Q000009:adverse effects* / Q000401:mortality; D055815:Young Adult
Anastomotic leak; Biliary fistula; Hepaticojejunostomy; Pancreaticojejunostomy; Pancreatoduodenectomy; Whipple