Defining Treatment and Outcomes of Hepaticojejunostomy Failure Following Pancreaticoduodenectomy

Richard A. Burkhart, Daniel Relles, Danielle M. Pineda, Salil Gabale, Patricia K. Sauter, Ernest L. Rosato, Leonidas G. Koniaris, Harish Lavu, Eugene P. Kennedy, Charles J. Yeo, Jordan M. Winter

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: The overall complication rate after pancreaticoduodenectomy (PD) approaches 50 %, with anastomotic failure being the most frequent cause of serious postoperative morbidity. Hepaticojejunostomy leaks (also called bile leaks) are the second most common type of leak, behind pancreaticojejunostomy leaks, yet have been the focus of only a single study as reported by Suzuki et al. (Hepatogastroenterology 50:254-257, 12). Methods: We reviewed the recent experience with bile leaks at a single, high-volume pancreatic surgery center over a six-year time period. Results: Bile leaks were identified in 16 out of 715 patients (2. 2 %). Low preoperative albumin was associated with an increased risk. Bile leaks typically manifested within the first week after surgery as bilious drainage in a surgically placed drain. Associated warning signs included fever and leukocytosis. Patients with a bile leak frequently developed other complications, including a pancreatic fistula, wound infection, delayed gastric emptying, and sepsis. The impact on perioperative outcomes was comparable to patients with a pancreatic leak. A grading system is proposed based on the International Study Group on Pancreatic Fistula model. Grade A bile leaks were classified as those managed with prolonged drainage by operatively placed drains, grade B bile leaks with percutaneous abdominal drainage, and grade C bile leaks with insertion of a percutaneous transhepatic biliary drainage. Conclusions: Hepaticojejunostomy leaks are rare after PD. The complication severity ranges from trivial to life threatening and is comparable overall to pancreaticojejunostomy leaks. Surgical intervention is rarely, if ever, required. With prompt and aggressive management, a full recovery can be expected.

Original languageEnglish (US)
Pages (from-to)451-460
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume17
Issue number3
DOIs
StatePublished - Jan 7 2013

Fingerprint

Pancreaticoduodenectomy
Bile
Drainage
Pancreaticojejunostomy
Pancreatic Fistula
Gastric Emptying
Leukocytosis
Wound Infection
Albumins
Sepsis
Fever
Morbidity

Keywords

  • Bile leak
  • Hepaticojejunostomy
  • Pancreaticoduodenectomy
  • Whipple operation

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Burkhart, R. A., Relles, D., Pineda, D. M., Gabale, S., Sauter, P. K., Rosato, E. L., ... Winter, J. M. (2013). Defining Treatment and Outcomes of Hepaticojejunostomy Failure Following Pancreaticoduodenectomy. Journal of Gastrointestinal Surgery, 17(3), 451-460. https://doi.org/10.1007/s11605-012-2118-9

Defining Treatment and Outcomes of Hepaticojejunostomy Failure Following Pancreaticoduodenectomy. / Burkhart, Richard A.; Relles, Daniel; Pineda, Danielle M.; Gabale, Salil; Sauter, Patricia K.; Rosato, Ernest L.; Koniaris, Leonidas G.; Lavu, Harish; Kennedy, Eugene P.; Yeo, Charles J.; Winter, Jordan M.

In: Journal of Gastrointestinal Surgery, Vol. 17, No. 3, 07.01.2013, p. 451-460.

Research output: Contribution to journalArticle

Burkhart, RA, Relles, D, Pineda, DM, Gabale, S, Sauter, PK, Rosato, EL, Koniaris, LG, Lavu, H, Kennedy, EP, Yeo, CJ & Winter, JM 2013, 'Defining Treatment and Outcomes of Hepaticojejunostomy Failure Following Pancreaticoduodenectomy', Journal of Gastrointestinal Surgery, vol. 17, no. 3, pp. 451-460. https://doi.org/10.1007/s11605-012-2118-9
Burkhart, Richard A. ; Relles, Daniel ; Pineda, Danielle M. ; Gabale, Salil ; Sauter, Patricia K. ; Rosato, Ernest L. ; Koniaris, Leonidas G. ; Lavu, Harish ; Kennedy, Eugene P. ; Yeo, Charles J. ; Winter, Jordan M. / Defining Treatment and Outcomes of Hepaticojejunostomy Failure Following Pancreaticoduodenectomy. In: Journal of Gastrointestinal Surgery. 2013 ; Vol. 17, No. 3. pp. 451-460.
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abstract = "Background: The overall complication rate after pancreaticoduodenectomy (PD) approaches 50 {\%}, with anastomotic failure being the most frequent cause of serious postoperative morbidity. Hepaticojejunostomy leaks (also called bile leaks) are the second most common type of leak, behind pancreaticojejunostomy leaks, yet have been the focus of only a single study as reported by Suzuki et al. (Hepatogastroenterology 50:254-257, 12). Methods: We reviewed the recent experience with bile leaks at a single, high-volume pancreatic surgery center over a six-year time period. Results: Bile leaks were identified in 16 out of 715 patients (2. 2 {\%}). Low preoperative albumin was associated with an increased risk. Bile leaks typically manifested within the first week after surgery as bilious drainage in a surgically placed drain. Associated warning signs included fever and leukocytosis. Patients with a bile leak frequently developed other complications, including a pancreatic fistula, wound infection, delayed gastric emptying, and sepsis. The impact on perioperative outcomes was comparable to patients with a pancreatic leak. A grading system is proposed based on the International Study Group on Pancreatic Fistula model. Grade A bile leaks were classified as those managed with prolonged drainage by operatively placed drains, grade B bile leaks with percutaneous abdominal drainage, and grade C bile leaks with insertion of a percutaneous transhepatic biliary drainage. Conclusions: Hepaticojejunostomy leaks are rare after PD. The complication severity ranges from trivial to life threatening and is comparable overall to pancreaticojejunostomy leaks. Surgical intervention is rarely, if ever, required. With prompt and aggressive management, a full recovery can be expected.",
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AU - Relles, Daniel

AU - Pineda, Danielle M.

AU - Gabale, Salil

AU - Sauter, Patricia K.

AU - Rosato, Ernest L.

AU - Koniaris, Leonidas G.

AU - Lavu, Harish

AU - Kennedy, Eugene P.

AU - Yeo, Charles J.

AU - Winter, Jordan M.

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N2 - Background: The overall complication rate after pancreaticoduodenectomy (PD) approaches 50 %, with anastomotic failure being the most frequent cause of serious postoperative morbidity. Hepaticojejunostomy leaks (also called bile leaks) are the second most common type of leak, behind pancreaticojejunostomy leaks, yet have been the focus of only a single study as reported by Suzuki et al. (Hepatogastroenterology 50:254-257, 12). Methods: We reviewed the recent experience with bile leaks at a single, high-volume pancreatic surgery center over a six-year time period. Results: Bile leaks were identified in 16 out of 715 patients (2. 2 %). Low preoperative albumin was associated with an increased risk. Bile leaks typically manifested within the first week after surgery as bilious drainage in a surgically placed drain. Associated warning signs included fever and leukocytosis. Patients with a bile leak frequently developed other complications, including a pancreatic fistula, wound infection, delayed gastric emptying, and sepsis. The impact on perioperative outcomes was comparable to patients with a pancreatic leak. A grading system is proposed based on the International Study Group on Pancreatic Fistula model. Grade A bile leaks were classified as those managed with prolonged drainage by operatively placed drains, grade B bile leaks with percutaneous abdominal drainage, and grade C bile leaks with insertion of a percutaneous transhepatic biliary drainage. Conclusions: Hepaticojejunostomy leaks are rare after PD. The complication severity ranges from trivial to life threatening and is comparable overall to pancreaticojejunostomy leaks. Surgical intervention is rarely, if ever, required. With prompt and aggressive management, a full recovery can be expected.

AB - Background: The overall complication rate after pancreaticoduodenectomy (PD) approaches 50 %, with anastomotic failure being the most frequent cause of serious postoperative morbidity. Hepaticojejunostomy leaks (also called bile leaks) are the second most common type of leak, behind pancreaticojejunostomy leaks, yet have been the focus of only a single study as reported by Suzuki et al. (Hepatogastroenterology 50:254-257, 12). Methods: We reviewed the recent experience with bile leaks at a single, high-volume pancreatic surgery center over a six-year time period. Results: Bile leaks were identified in 16 out of 715 patients (2. 2 %). Low preoperative albumin was associated with an increased risk. Bile leaks typically manifested within the first week after surgery as bilious drainage in a surgically placed drain. Associated warning signs included fever and leukocytosis. Patients with a bile leak frequently developed other complications, including a pancreatic fistula, wound infection, delayed gastric emptying, and sepsis. The impact on perioperative outcomes was comparable to patients with a pancreatic leak. A grading system is proposed based on the International Study Group on Pancreatic Fistula model. Grade A bile leaks were classified as those managed with prolonged drainage by operatively placed drains, grade B bile leaks with percutaneous abdominal drainage, and grade C bile leaks with insertion of a percutaneous transhepatic biliary drainage. Conclusions: Hepaticojejunostomy leaks are rare after PD. The complication severity ranges from trivial to life threatening and is comparable overall to pancreaticojejunostomy leaks. Surgical intervention is rarely, if ever, required. With prompt and aggressive management, a full recovery can be expected.

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