The Impact of Hepaticojejunostomy Leaks After Pancreatoduodenectomy: a Devastating Source of Morbidity and Mortality

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

doi:10.1007/s11605-017-3406-1

Cited by 26 publications

(19 citation statements)

References 18 publications

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“…HPB severity of bile leaks too. 17 Our results support these findings with the highest rate of bile leaks being observed in the SL group. Of the various published clinical studies assessing the value of diverting bile from pancreatic juice via an isolated loop reconstruction only three were randomized controlled trials (RCT).…”

supporting

confidence: 86%

A modified single-loop reconstruction after pancreaticoduodenectomy reduces severity of postoperative pancreatic fistula in high-risk patients

Aghalarov

Herzog

Uhl

et al. 2018

HPB

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supporting

confidence: 86%

A modified single-loop reconstruction after pancreaticoduodenectomy reduces severity of postoperative pancreatic fistula in high-risk patients

Aghalarov

Herzog

Uhl

et al. 2018

HPB

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“…PD patients require three types of anastomoses to retain gastrointestinal continuity: pancreaticojejunal (PJ), gastrojejunal (GJ), and hepaticojejunal (HJ) anastomoses. Such anastomoses are the most problematic sites following PD, and anastomotic leakages (ALs) from these sites are important contributors to postoperative morbidity, prolonged hospitalization, and mortality after PD [1,2]. Thus, several efforts have been made to identify their risk factors [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Effect of postoperative non-steroidal anti-inflammatory drugs on anastomotic leakage after pancreaticoduodenectomy

Yoon

Kim

Cho

et al. 2022

Korean J Anesthesiol

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“…Albeit the difficulty of the HJ is well-known among hepatobiliary surgeons, no comprehensive data are available on the incidence and clinical significance of anastomotic leakage (AL) and anastomotic stenosis (AS) following HJ in pCCA patients. AL is mainly investigated after pancreaticoduodenectomy and reported to occur in 2% to 8% of all patients undergoing the procedure [11][12][13]. Risk factors for postoperative leakage in this scenario are an increased body mass index (BMI), preoperative endoscopic biliary drainage (EBD) and an anastomosis on segmental bile ducts [14].…”

Section: Introductionmentioning

confidence: 99%

Leakage and Stenosis of the Hepaticojejunostomy Following Surgery for Perihilar Cholangiocarcinoma

Bednarsch

Czigány

Heise

et al. 2020

JCM

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This study aims to provide a deep insight into the incidence and clinical significance of postoperative anastomotic leakage (AL) and anastomotic stenosis (AS) of the hepaticojejunostomy (HJ) after curative-intent liver resection for perihilar cholangiocarcinoma (pCCA). Between 2011 and mid-2019, 114 patients with pCCA underwent surgery in curative intent at our institution and were analyzed regarding the postoperative incidence of AL and AS. Further, associations between AL and AS and clinical characteristics were assessed using multiple univariate logistic regression analyses. AL was diagnosed in 11.4% (13/114) of the patients resulting in postoperative mortality in the minority of patients (23.0%, 3/13). AS occurred in 11.0% (11/100) of the individuals eligible for follow-up with local tumor recurrence being the underlying pathology in 72.7% (8/11) of the cases. None of the investigated clinical factors including surgical difficulty of the HJ showed a meaningful association with AL or AS. AL and AS are frequent complications and can be treated by conservative, interventional or surgical therapy with a high success rate. Also, technical difficulty of the HJ appears not to be not associated with the occurrence of AL or AS. Moreover, AS is associated with tumor recurrence in the majority of cases.

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The Impact of Hepaticojejunostomy Leaks After Pancreatoduodenectomy: a Devastating Source of Morbidity and Mortality

Abstract: Hepaticojejunostomy and combined leaks after pancreatoduodenectomy are rarer than pancreaticojejunostomy leaks; these patients are at a significantly increased risk of major morbidity and mortality.

Cited by 26 publications

References 18 publications

A modified single-loop reconstruction after pancreaticoduodenectomy reduces severity of postoperative pancreatic fistula in high-risk patients

A modified single-loop reconstruction after pancreaticoduodenectomy reduces severity of postoperative pancreatic fistula in high-risk patients

Effect of postoperative non-steroidal anti-inflammatory drugs on anastomotic leakage after pancreaticoduodenectomy

Leakage and Stenosis of the Hepaticojejunostomy Following Surgery for Perihilar Cholangiocarcinoma

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