Transient Biliary Fistula After Pancreatoduodenectomy Increases Risk of Biliary Anastomotic Stricture
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 per...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2021-01, Vol.25 (1), p.169-177 |
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| creator | Maatman, Thomas K. Loncharich, Alexa J. Flick, Katelyn F. Simpson, Rachel E. Ceppa, Eugene P. Nakeeb, Attila Nguyen, Trang K. Schmidt, C. Max Zyromski, Nicholas J. House, Michael G. |
| description | 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. |
| doi_str_mv | 10.1007/s11605-020-04727-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2424447356</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2424447356</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-a9bbabd7cc2778496baaca440beb4f9095e8febf34c5d49b00ba189eba2c2d993</originalsourceid><addsrcrecordid>eNp9kU9PxCAQxYnRuP77Ah5MEy9eqkBpKcd14-omJhpdE28E6NSg3aJAD_vtxd1VEw-emMDvvRnmIXRM8DnBmF8EQipc5pjiHDNOeb7cQnuk5kXOKlptpxoLktOyfB6h_RBeMSYck3oXjQpaccKF2EMw96oPFvqYXdrOKr_MpjbEoVPZuI3gs3vVGw8qumZwDfRgolsss9nqMkDIHmx4y1z7ox73KiTERWuyx-itiYOHQ7TTqi7A0eY8QE_Tq_nkJr-9u55Nxre5YYzEXAmtlW64MZTzmolKK2UUY1iDZq3AooS6Bd0WzJQNExpjrUgtQCtqaCNEcYDO1r7v3n0MEKJc2GCg61QPbgiSMsoY40VZJfT0D_rqBt-n6RJVM5YmoDxRdE0Z70Lw0Mp3bxfpn5Jg-RWCXIcgUwhyFYJcJtHJxnrQC2h-JN9bT0CxBkJ66l_A__b-x_YTKH6VEA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2484427727</pqid></control><display><type>article</type><title>Transient Biliary Fistula After Pancreatoduodenectomy Increases Risk of Biliary Anastomotic Stricture</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Maatman, Thomas K. ; Loncharich, Alexa J. ; Flick, Katelyn F. ; Simpson, Rachel E. ; Ceppa, Eugene P. ; Nakeeb, Attila ; Nguyen, Trang K. ; Schmidt, C. Max ; Zyromski, Nicholas J. ; House, Michael G.</creator><creatorcontrib>Maatman, Thomas K. ; Loncharich, Alexa J. ; Flick, Katelyn F. ; Simpson, Rachel E. ; Ceppa, Eugene P. ; Nakeeb, Attila ; Nguyen, Trang K. ; Schmidt, C. Max ; Zyromski, Nicholas J. ; House, Michael G.</creatorcontrib><description>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.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-020-04727-y</identifier><identifier>PMID: 32671799</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Anastomosis, Surgical - adverse effects ; Bile ; Biliary Fistula - etiology ; Constriction, Pathologic - etiology ; Constriction, Pathologic - surgery ; Endoscopy ; Fistula ; Gastroenterology ; Humans ; Liver ; Medicine ; Medicine & Public Health ; Morbidity ; Mortality ; Pancreaticoduodenectomy ; Pancreaticoduodenectomy - adverse effects ; Patients ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - surgery ; Retrospective Studies ; SSAT Quick Shot Presentation ; Surgery ; Treatment Outcome</subject><ispartof>Journal of gastrointestinal surgery, 2021-01, Vol.25 (1), p.169-177</ispartof><rights>The Society for Surgery of the Alimentary Tract 2020</rights><rights>The Society for Surgery of the Alimentary Tract 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-a9bbabd7cc2778496baaca440beb4f9095e8febf34c5d49b00ba189eba2c2d993</citedby><cites>FETCH-LOGICAL-c441t-a9bbabd7cc2778496baaca440beb4f9095e8febf34c5d49b00ba189eba2c2d993</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-020-04727-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-020-04727-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32671799$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maatman, Thomas K.</creatorcontrib><creatorcontrib>Loncharich, Alexa J.</creatorcontrib><creatorcontrib>Flick, Katelyn F.</creatorcontrib><creatorcontrib>Simpson, Rachel E.</creatorcontrib><creatorcontrib>Ceppa, Eugene P.</creatorcontrib><creatorcontrib>Nakeeb, Attila</creatorcontrib><creatorcontrib>Nguyen, Trang K.</creatorcontrib><creatorcontrib>Schmidt, C. Max</creatorcontrib><creatorcontrib>Zyromski, Nicholas J.</creatorcontrib><creatorcontrib>House, Michael G.</creatorcontrib><title>Transient Biliary Fistula After Pancreatoduodenectomy Increases Risk of Biliary Anastomotic Stricture</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>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.</description><subject>Anastomosis, Surgical - adverse effects</subject><subject>Bile</subject><subject>Biliary Fistula - etiology</subject><subject>Constriction, Pathologic - etiology</subject><subject>Constriction, Pathologic - surgery</subject><subject>Endoscopy</subject><subject>Fistula</subject><subject>Gastroenterology</subject><subject>Humans</subject><subject>Liver</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Pancreaticoduodenectomy</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - surgery</subject><subject>Retrospective Studies</subject><subject>SSAT Quick Shot Presentation</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU9PxCAQxYnRuP77Ah5MEy9eqkBpKcd14-omJhpdE28E6NSg3aJAD_vtxd1VEw-emMDvvRnmIXRM8DnBmF8EQipc5pjiHDNOeb7cQnuk5kXOKlptpxoLktOyfB6h_RBeMSYck3oXjQpaccKF2EMw96oPFvqYXdrOKr_MpjbEoVPZuI3gs3vVGw8qumZwDfRgolsss9nqMkDIHmx4y1z7ox73KiTERWuyx-itiYOHQ7TTqi7A0eY8QE_Tq_nkJr-9u55Nxre5YYzEXAmtlW64MZTzmolKK2UUY1iDZq3AooS6Bd0WzJQNExpjrUgtQCtqaCNEcYDO1r7v3n0MEKJc2GCg61QPbgiSMsoY40VZJfT0D_rqBt-n6RJVM5YmoDxRdE0Z70Lw0Mp3bxfpn5Jg-RWCXIcgUwhyFYJcJtHJxnrQC2h-JN9bT0CxBkJ66l_A__b-x_YTKH6VEA</recordid><startdate>20210101</startdate><enddate>20210101</enddate><creator>Maatman, Thomas K.</creator><creator>Loncharich, Alexa J.</creator><creator>Flick, Katelyn F.</creator><creator>Simpson, Rachel E.</creator><creator>Ceppa, Eugene P.</creator><creator>Nakeeb, Attila</creator><creator>Nguyen, Trang K.</creator><creator>Schmidt, C. Max</creator><creator>Zyromski, Nicholas J.</creator><creator>House, Michael G.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20210101</creationdate><title>Transient Biliary Fistula After Pancreatoduodenectomy Increases Risk of Biliary Anastomotic Stricture</title><author>Maatman, Thomas K. ; Loncharich, Alexa J. ; Flick, Katelyn F. ; Simpson, Rachel E. ; Ceppa, Eugene P. ; Nakeeb, Attila ; Nguyen, Trang K. ; Schmidt, C. Max ; Zyromski, Nicholas J. ; House, Michael G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-a9bbabd7cc2778496baaca440beb4f9095e8febf34c5d49b00ba189eba2c2d993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anastomosis, Surgical - adverse effects</topic><topic>Bile</topic><topic>Biliary Fistula - etiology</topic><topic>Constriction, Pathologic - etiology</topic><topic>Constriction, Pathologic - surgery</topic><topic>Endoscopy</topic><topic>Fistula</topic><topic>Gastroenterology</topic><topic>Humans</topic><topic>Liver</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Pancreaticoduodenectomy</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Patients</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - surgery</topic><topic>Retrospective Studies</topic><topic>SSAT Quick Shot Presentation</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maatman, Thomas K.</creatorcontrib><creatorcontrib>Loncharich, Alexa J.</creatorcontrib><creatorcontrib>Flick, Katelyn F.</creatorcontrib><creatorcontrib>Simpson, Rachel E.</creatorcontrib><creatorcontrib>Ceppa, Eugene P.</creatorcontrib><creatorcontrib>Nakeeb, Attila</creatorcontrib><creatorcontrib>Nguyen, Trang K.</creatorcontrib><creatorcontrib>Schmidt, C. Max</creatorcontrib><creatorcontrib>Zyromski, Nicholas J.</creatorcontrib><creatorcontrib>House, Michael G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maatman, Thomas K.</au><au>Loncharich, Alexa J.</au><au>Flick, Katelyn F.</au><au>Simpson, Rachel E.</au><au>Ceppa, Eugene P.</au><au>Nakeeb, Attila</au><au>Nguyen, Trang K.</au><au>Schmidt, C. Max</au><au>Zyromski, Nicholas J.</au><au>House, Michael G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transient Biliary Fistula After Pancreatoduodenectomy Increases Risk of Biliary Anastomotic Stricture</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2021-01-01</date><risdate>2021</risdate><volume>25</volume><issue>1</issue><spage>169</spage><epage>177</epage><pages>169-177</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32671799</pmid><doi>10.1007/s11605-020-04727-y</doi><tpages>9</tpages></addata></record> |
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| ispartof | Journal of gastrointestinal surgery, 2021-01, Vol.25 (1), p.169-177 |
| issn | 1091-255X 1873-4626 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Anastomosis, Surgical - adverse effects Bile Biliary Fistula - etiology Constriction, Pathologic - etiology Constriction, Pathologic - surgery Endoscopy Fistula Gastroenterology Humans Liver Medicine Medicine & Public Health Morbidity Mortality Pancreaticoduodenectomy Pancreaticoduodenectomy - adverse effects Patients Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - surgery Retrospective Studies SSAT Quick Shot Presentation Surgery Treatment Outcome |
| title | Transient Biliary Fistula After Pancreatoduodenectomy Increases Risk of Biliary Anastomotic Stricture |
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