Bilioenteric anastomoses (BEA), frequently performed during pancreatic head resections, can be performed with a very low rate of early anastomotic complications. However, data on the long-term outcomes are rare. We here report our perioperative experience with more than 500 BEAs, most of them performed as a part of pancreatic surgery. In addition, long-term outcomes regarding BA were also available in more than 150 patients.
Methods: For this study we reviewed our prospective pancreatic and biliary databases and identified 553 patients with BEA. Patients having a BEA during hepatic surgery including hilar cholangiocarcinoma were not considered. BEAs were performed as a part of pancreatic head resection (76%), palliative single oder double bypass procedures (17%) or as isolated BEA-procedures (most of them for benign strictures (7%). Indications for surgery/BEA were pancreatic or periampullary cancer (50%), chronic pancreatitis 832%) or various others (18%). Ninenty-six percent of the BEAs were performed by interrupted monofil sutures. Soft silicon drains were always placed at the BEA at the end of surgery. Long-term follow-up included especially patients with chronic pancreatitis.
Results: Operative mortality was 2.5%. No patient died because of complications of the BEA. In the early postoperative period four patients (1%) developed a symptomatic stenosis of the BEA requiring re-operation (n=3) or interventional therapy (n=1). Ten patients (2%) had a leakage of the BEA successful treated by re-operation (n=6) or conservatively (n=4). A clinically relevant cholangitis was seen in 2% of the cases after BEA.Median survival was 7 months after palliative bypass and in the range of 18 to 24 months in patients with pancreatic or different subtypes of periampullary cancer. Up to now long-term patency of the BEA could be evaluated in 140 patients with chronic pancreatitis and 18 patients with benign biliary structures with a median follow-up of four years. Five of those 158 patients (3%) developed symptomatic late stenosis (two after duodenum-preserving resection, two after PPPD and one after BEA) treated by surgery or interventionally.
Conclusions: Early complications after BEA are rare and can be managed successfully by operative or interventional measures. The long-term patency (in benign diseases) is good with only very few patients requiring therapy for late stenosis.