Tomonari Asano1,2, Seiji Natsume3, Yoshiki Senda1, Tsuyoshi Sano4, Keitaro Matsuo5, Yasuhiro Kodera2, Kazuo Hara6, Seiji Ito1, Kenji Yamao6, Yasuhiro Shimizu1. 1. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan. 2. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan. 3. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan. seijinn@hotmail.com. 4. Department of Gastroenterological Surgery, Aichi Medical University Hospital, Nagakute, Japan. 5. Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan. 6. Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
Abstract
BACKGROUND: There have been no reports showing the incidence of anastomotic stenosis of continuous hepaticojejunostomy (HJ) and identifying its risk factors for patients who underwent pancreaticoduodenectomy (PD). METHOD: We retrospectively investigated 200 patients whose HJ was established by unified method, single layered continuous suture. HJ stenosis was diagnosed with endoscopic or radiologic examinations. Uni and multivariable unconditional logistic modeling were performed to explore the predictive factors and to estimate odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: Sixteen patients (8.0%) were diagnosed as HJ stenosis. Multivariable analysis showed that body mass index (BMI) (OR: 1.24; 95% CI: 1.03-1.51), absence of preoperative biliary stenting (OR: 11.10; 95% CI: 1.22-101.12), operative time (OR: 1.74 per one hour increase; 95% CI: 1.01-2.98), age (OR: 1.58 per 10 years increase; 95% CI: 0.88-2.85), and absence of nodal metastasis (OR: 3.43; 95% CI: 0.90-13.12) correlated with HJ stenosis. Among these, BMI and preoperative biliary stenting were associated with stenosis with a lower P-value than the others (P = 0.026 and 0.033, respectively). CONCLUSIONS: The incidence of HJ stenosis was 8.0%. Close attention would be needed especially for patients at high risk of HJ stenosis, such as high BMI or absence of preoperative biliary stenting.
BACKGROUND: There have been no reports showing the incidence of anastomotic stenosis of continuous hepaticojejunostomy (HJ) and identifying its risk factors for patients who underwent pancreaticoduodenectomy (PD). METHOD: We retrospectively investigated 200 patients whose HJ was established by unified method, single layered continuous suture. HJ stenosis was diagnosed with endoscopic or radiologic examinations. Uni and multivariable unconditional logistic modeling were performed to explore the predictive factors and to estimate odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: Sixteen patients (8.0%) were diagnosed as HJ stenosis. Multivariable analysis showed that body mass index (BMI) (OR: 1.24; 95% CI: 1.03-1.51), absence of preoperative biliary stenting (OR: 11.10; 95% CI: 1.22-101.12), operative time (OR: 1.74 per one hour increase; 95% CI: 1.01-2.98), age (OR: 1.58 per 10 years increase; 95% CI: 0.88-2.85), and absence of nodal metastasis (OR: 3.43; 95% CI: 0.90-13.12) correlated with HJ stenosis. Among these, BMI and preoperative biliary stenting were associated with stenosis with a lower P-value than the others (P = 0.026 and 0.033, respectively). CONCLUSIONS: The incidence of HJ stenosis was 8.0%. Close attention would be needed especially for patients at high risk of HJ stenosis, such as high BMI or absence of preoperative biliary stenting.
Authors: Maximilian Brunner; Jessica Stockheim; Christian Krautz; Dimitrios Raptis; Stephan Kersting; Georg F Weber; Robert Grützmann Journal: BMC Surg Date: 2018-10-11 Impact factor: 2.102