Hepaticojejunostomy – Definition of risk factors for postoperative bile leaks

Introduction:

Anastomoses between the jejunum and the bile duct are an important component of many surgical procedures; 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 October 2001 and April 2004, a hepaticojejunostomy was performed in 434 patients at our institution. Patient and treatment related data of these patients were documented prospectively. A bile leak was 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.

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.

Results:

Included in this study were 434 patients (268 male, 166 female) with a median age of 62. The overall complication rate was 34% (n=148) with bile leaks occurring in 5% of patients (n=22). Type of operation was a significant factor in predicting a postoperative bile leak: in patients undergoing liver resection in combination with a hepaticojejunostomy the bile leak rate was 25% compared to 4.5% for the other procedures (p=0.02). Patients with a bile leak had a lower preoperative ChE level compared to patients without bile leak (p=0.005). Both factors were independent predictors of a postoperative bile leak in multivariate logistic regression

Conclusion:

Hepaticojejunostomy can be performed with a low postoperative complication rate if performed in a standardised way. Simultaneous liver resection and low preoperative ChE levels are risk factors for postoperative bile leaks. The prognostic impact of preoperative ChE strongly points towards the influence of liver function in the healing process of a hepaticojejunostomy. The results of this study might help in developing strategies for further improving outcome of hepaticojejunostomy.