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01-01-2021 | Pancreatoduodenostomy | SSAT Quick Shot Presentation

Transient Biliary Fistula After Pancreatoduodenectomy Increases Risk of Biliary Anastomotic Stricture

Authors: Thomas K. Maatman, Alexa J. Loncharich, Katelyn F. Flick, Rachel E. Simpson, Eugene P. Ceppa, Attila Nakeeb, Trang K. Nguyen, C. Max Schmidt, Nicholas J. Zyromski, Michael G. House

Published in: Journal of Gastrointestinal Surgery | Issue 1/2021

Abstract

Background

Biliary fistula after pancreatoduodenectomy (PD) is associated with significant morbidity and mortality. The aim of this study was to determine the risk of early postoperative biliary fistula for developing biliary anastomotic stricture after PD.

Methods

Retrospective review of all PD performed for various indications at a single institution between 2013 and 2018. Postoperative biliary fistulae were graded according to the International Study Group of Liver Surgery (ISGLS) as grade A–C. Multivariable analysis was performed for all comparative patient subgroups.

Results

A total of 843 patients underwent PD for malignant (68%) and benign (32%) indications. Postoperative biliary fistula developed in 66 (8%) patients; ISGLS grade A in 29 (3%), grade B in 32 (4%), and grade C in 5 (0.6%). Ninety-day mortality was 3% (25 patients). The remaining 818 patients were evaluated with a median follow-up of 16 months (IQR, 5–32 months). Biliary anastomotic stricture developed in 41 (5%) patients at a median of 10 months (IQR, 6–18 months) postoperatively. Strictures were managed with percutaneous (27 patients, 66%) or endoscopic (14 patients, 34%) stenting. No biliary stricture required operative anastomotic revision. Postoperative biliary fistula (HR, 4.4; 95% CI, 2.0–9.9; P = 0.0002) was associated with biliary anastomotic stricture; an increased risk for biliary anastomotic stricture was seen in patients with grade A (HR, 6.4; 95% CI, 2.4–16.9; P = 0.0002) and grade B (HR, 3.6; 95% CI, 1.2–10.9; P = 0.02) postoperative biliary fistula.

Conclusion

Postoperative biliary fistula after pancreatoduodenectomy, including clinically insignificant, transient biliary fistula, is associated with an increased risk of a late biliary anastomotic stricture requiring stenting.

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Title: Transient Biliary Fistula After Pancreatoduodenectomy Increases Risk of Biliary Anastomotic Stricture
Authors: Thomas K. Maatman
Alexa J. Loncharich
Katelyn F. Flick
Rachel E. Simpson
Eugene P. Ceppa
Attila Nakeeb
Trang K. Nguyen
C. Max Schmidt
Nicholas J. Zyromski
Michael G. House
Publication date: 01-01-2021
Publisher: Springer US
Keywords: Pancreatoduodenostomy
Pancreatoduodenostomy
Published in: Journal of Gastrointestinal Surgery / Issue 1/2021
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-020-04727-y

At a glance: The STEP trials

Springer Medicine

Transient Biliary Fistula After Pancreatoduodenectomy Increases Risk of Biliary Anastomotic Stricture

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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