The Impact of Hepaticojejunostomy Leaks After Pancreatoduodenectomy

a Devastating Source of Morbidity and Mortality

Andrea L. Jester, Catherine W. Chung, David C. Becerra, E. Molly Kilbane, Michael House, Nicholas Zyromski, C. Schmidt, Attila Nakeeb, Eugene P. Ceppa

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: 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. Methods: Consecutive cases of pancreatoduodenectomy (n = 924) were reviewed at a single high-volume institution over an 8-year period (2006–2014). Results: 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). Conclusions: Hepaticojejunostomy and combined leaks after pancreatoduodenectomy are rarer than pancreaticojejunostomy leaks; these patients are at a significantly increased risk of major morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Mar 24 2017

Fingerprint

Pancreaticojejunostomy
Pancreaticoduodenectomy
Morbidity
Mortality
Length of Stay

Keywords

  • Anastomotic leak
  • Biliary fistula
  • Hepaticojejunostomy
  • Pancreaticojejunostomy
  • Pancreatoduodenectomy
  • Whipple

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

The Impact of Hepaticojejunostomy Leaks After Pancreatoduodenectomy : a Devastating Source of Morbidity and Mortality. / Jester, Andrea L.; Chung, Catherine W.; Becerra, David C.; Molly Kilbane, E.; House, Michael; Zyromski, Nicholas; Schmidt, C.; Nakeeb, Attila; Ceppa, Eugene P.

In: Journal of Gastrointestinal Surgery, 24.03.2017, p. 1-8.

Research output: Contribution to journalArticle

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abstract = "Introduction: 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. Methods: Consecutive cases of pancreatoduodenectomy (n = 924) were reviewed at a single high-volume institution over an 8-year period (2006–2014). Results: 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). Conclusions: Hepaticojejunostomy and combined leaks after pancreatoduodenectomy are rarer than pancreaticojejunostomy leaks; these patients are at a significantly increased risk of major morbidity and mortality.",
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T1 - The Impact of Hepaticojejunostomy Leaks After Pancreatoduodenectomy

T2 - a Devastating Source of Morbidity and Mortality

AU - Jester, Andrea L.

AU - Chung, Catherine W.

AU - Becerra, David C.

AU - Molly Kilbane, E.

AU - House, Michael

AU - Zyromski, Nicholas

AU - Schmidt, C.

AU - Nakeeb, Attila

AU - Ceppa, Eugene P.

PY - 2017/3/24

Y1 - 2017/3/24

N2 - Introduction: 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. Methods: Consecutive cases of pancreatoduodenectomy (n = 924) were reviewed at a single high-volume institution over an 8-year period (2006–2014). Results: 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). Conclusions: Hepaticojejunostomy and combined leaks after pancreatoduodenectomy are rarer than pancreaticojejunostomy leaks; these patients are at a significantly increased risk of major morbidity and mortality.

AB - Introduction: 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. Methods: Consecutive cases of pancreatoduodenectomy (n = 924) were reviewed at a single high-volume institution over an 8-year period (2006–2014). Results: 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). Conclusions: Hepaticojejunostomy and combined leaks after pancreatoduodenectomy are rarer than pancreaticojejunostomy leaks; these patients are at a significantly increased risk of major morbidity and mortality.

KW - Anastomotic leak

KW - Biliary fistula

KW - Hepaticojejunostomy

KW - Pancreaticojejunostomy

KW - Pancreatoduodenectomy

KW - Whipple

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