Risk factors for postoperative cholangitis after pancreaticoduodenectomy and evaluation of internal stenting on hepaticojejunostomy: A single‐center propensity score‐based analysis

Abstract

Background/PurposeThis retrospective study aimed to investigate the risk factors for postoperative cholangitis (POC) after pancreaticoduodenectomy (PD) and the efficacy of stenting on hepaticojejunostomy (HJ).MethodsWe investigated 162 patients. Postoperative cholangitis occurring before and after discharge was defined as early‐onset POC (E‐POC) and late‐onset POC (L‐POC), respectively. Risk factors for E‐POC and L‐POC were identified using univariate and multivariate logistic regression analyses. Propensity score matching (PSM) between the stenting group (group S) and the non‐stenting group (group NS), and subgroup analysis in patients with risk factors were performed to evaluate the efficacy of stenting on HJ in preventing POC.ResultsBody mass index (BMI) ≥ 25 kg/m2 and preoperative non‐biliary drainage (BD) were risk factors for E‐POC and L‐POC, respectively. PSM analysis revealed that E‐POC occurrence was significantly higher in group S than in group NS (P = .045). In the preoperative non‐BD group (n = 69), E‐POC occurrence was significantly higher in group S than in group NS (P = .025).ConclusionsBMI ≥ 25 kg/m2 and preoperative non‐BD status were risk factors for E‐POC and L‐POC, respectively. Stenting on HJ implants did not prevent POC after PD.

Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis

“…These seven variables have been identified as clinicopathologic factors that could contribute to the development of cholangitis. [15][16][17][18] The Kaplan-Meier method was used to compare the accumulated incidence of medium-term postoperative cholangitis between the standard anastomosis group and the T-shaped anastomosis group.…”

“…To reduce the effect of selection bias, propensity score analysis was performed using the following covariates: age, BMI, previous abdominal surgery, common hepatic duct diameter on preoperative CT, primary disease (pancreatic cancer/other), preoperative biliary drainage, and preoperative cholangitis. These seven variables have been identified as clinicopathologic factors that could contribute to the development of cholangitis 15–18 . The Kaplan–Meier method was used to compare the accumulated incidence of medium‐term postoperative cholangitis between the standard anastomosis group and the T‐shaped anastomosis group.…”

“…These seven variables have been identified as clinicopathologic factors that could contribute to the development of cholangitis. 15 , 16 , 17 , 18 The Kaplan–Meier method was used to compare the accumulated incidence of medium‐term postoperative cholangitis between the standard anastomosis group and the T‐shaped anastomosis group. We used univariate and multivariate logistic regression to generate odds ratios (ORs), including 95% CIs, for clinical factors that would predict medium‐term postoperative cholangitis.…”

“…There have been several reports on risk factors for cholangitis after PD. Reported risk factors for cholangitis include preoperative small bile duct diameter, high BMI, male sex, preoperative biliary drainage, continuous suture of bile duct jejunal anastomosis, postoperative hepatolithiasis, and postoperative anastomotic stricture 15–18 . However, these factors are often not addressed by preoperative intervention.…”

“…Reported risk factors for cholangitis include preoperative small bile duct diameter, high BMI, male sex, preoperative biliary drainage, continuous suture of bile duct jejunal anastomosis, postoperative hepatolithiasis, and postoperative anastomotic stricture. 15 , 16 , 17 , 18 However, these factors are often not addressed by preoperative intervention. In this era of multidisciplinary treatment, we need specific techniques to decrease postoperative cholangitis; however, no novel anastomotic methods other than end‐to‐side choledochojejunostomy by interrupted suture have been reported.…”