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2006 Abstracts: Hepaticojejunostomy - Definition of risk factors for postoperative bile leaks
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Hepaticojejunostomy - Definition of risk factors for postoperative bile leaks
Jurgen Weitz, Dalibor Antolovic, Moritz Koch, Peter Kienle, Jan Schmidt, Helmut Friess, Markus Buechler; Department of Surgery, University of Heidelberg, Heidelberg, Germany

Anastomoses between the jejunum and the bile duct are frequently performed; however, the incidence of clinically relevant bile leaks after this procedure has not yet been adequately defined. The objective of this study was to describe the incidence of bile leaks after hepaticojejunostomy and to define factors associated with this risk. Materials and Methods Between 10/2001 and 05/2004, a hepaticojejunostomy was performed in 519 patients (318 male, 201 female, median age: 61 years) at our institution in a standardised way. Patient and treatment related data of these patients were analysed as risk factors for a bile leak defined as bilirubin concentration in the drain fluid exceeding serum bilirubin resulting in a change of clinical management or occurrence of a bilioma necessitating drainage. Statistical computations were done using the software package JMP. Continuous variables were expressed as medians and compared using the Wilcoxon Test while categorical variables were compared using the Fisher’s Exact or chi-square test. Multivariate logistic regression was performed by incorporating factors with a p-value ≤ 0.05 on univariate analysis. Statistical significance was defined as p ≤ 0.05. Results In addition to hepaticojejunostomy 321 patients underwent a pancreatic resection, 26 patients a liver transplantation and 10 patients a liver resection. The underlying diagnoses were pancreatic cancer (n=317), benign pancreatic tumours (n=28), tumours of the biliary system (n=34), liver cirrhosis (n=24), chronic pancreatitis (n=68), cholangitis (n=33), redo after liver transplantation (n=6), and others (n=9). The overall complication rate was 33% with bile leaks occurring in 5.6% of patients. The overall mortality rate was 1.3%. The table demonstrates the results of the multivariate logistic regression of factors predicting a bile leak. Conclusion Hepaticojejunostomy can be performed with a low postoperative complication rate if performed in a standardised way. Simultaneous liver resection, preoperative radio/chemotherapy, reoperation after liver transplantation and low preoperative ChE levels are risk factors for postoperative bile leaks. The results of this study might help in developing strategies for further improving outcome of hepaticojejunostomy.

Factor

Odds Ratio

95%-Confidence Interval

p-value

Liver resection

19.2

4.6 - 83

<0.001

Preop. Cholinesterase Level

0.87

0.75-1.0

0.05

Neoadj. Radio/Chemotherapy

3.8

1.4-10.9

0.01

Redo after Liver Transplantation

12.8

2.2-77

0.005


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