Outcomes of bilio-enteric anastomoses in a single, low volume hepato-pancreato biliary surgery unit in low income country

Abstract

Background: Hepaticojejunostomies (HJ) establish bilio-enteric continuity after resections for malignant and benign HPB disorders. The leak rates of HJs range from 2.2%-12.4% and contribute to morbidity and mortality. This study looks at the outcomes of patients who had a HJ in a low volume HPB surgical unit. Methods: Retrospective analysis of a patient database and records of HJs done at a single HPB surgical unit from 2011-21 was done. HJs were performed with a retro-colic Roux loop or single jejunal loop using single layer interrupted 4-0 or 5-0 polydiaxanone. Right subhepatic drains were placed. Results: Of the 97 patients, mean age was 51.86 years with a M:F ratio of 1:1.4. 64.9% (n = 63) of HJs were for malignancies while 35.1% (n = 34) were benign conditions. 56.7% (n = 55) had a HJ during a pancreaticoduodenectomy, 12.4% (n = 12) after extrahepatic bile duct resection and hepatectomy, 11.3% (n = 11) after choledochal cyst excision, 4.1% (n = 4) as palliative bypass procedures and 4.1% (n = 4) for repair of iatrogenic bile duct injuries. Bile leaks occurred in 3.1% (n = 3). Two occurred in HJs after hilar cholangiocarcinoma resections, where one persisted for 3 months -and the other led to mortality on the 15th postoperative day. The 3rd leak following choledochal cyst excision resolved in a day. Conclusions: Our results demonstrate excellent outcomes in terms of leak rates for HJs despite being a low volume HPB surgical centre. This is probably the result of meticulous surgical technique and peri-procedural care.