Early biliary complications after pancreaticoduodenectomy

Objective. To evaluate the frequency, risk factors and methods of treatment of early biliary complications after pancreaticoduodenectomy. Materials and Methods. A retrospective and prospective study was conducted, which included 451 patients who were treated at the National Research Center of Surgery and Transplantation named after A.A. Shalimov of the National Academy of Medical Sciences of Ukraine from January 2015 to December 2022. There were 235 men (52.1%) and 216 women (47.9%). The age of patients ranged from 35 to 80 years, with a mean age of (61± 9.3) years. Pancreaticoduodenectomy with preservation of the Traverso pancreas was performed in 135 patients, and with removal of the Whipple pancreas in 316 patients. The study patients underwent clinical, laboratory, bacteriological and instrumental examinations. Results. In 55 (12.2%) patients, early biliary complications occurred: in 6 (1.3%) - hepaticojejunoanastomosis stenosis, in 13 (2.9%) - temporary jaundice, in 10 (2.2%) - biliary hemorrhage and in 26 (5.8%) - cholangitis. In 6 patients with hepaticojejunoanastomosis stenosis, the diameter of the common bile duct was less than 5 mm, which statistically significantly (p < 0.001) influenced the development of early biliary complications, and 3 of these patients underwent repeated surgery. Temporary jaundice resolved spontaneously in all 13 patients. The jaundice stopped spontaneously in 5 patients, and the other 5 patients required minimally invasive treatment (4) or relaparotomy (1). Recurrent episodes of cholangitis were observed in 26 patients after discontinuation of antibiotic therapy. No patient died. The reoperation rate was 7%. Minimally invasive methods were successful in 11% of patients. Conclusions. The risk factors for the occurrence of biliary fistula after pancreaticoduodenectomy, the frequency of which was 2%, include male gender, obesity, low serum albumin levels, endobiliary stenting in the preoperative period, common bile duct diameter less than 5 mm, segmental bile duct anastomoses, and the fact that biliary leakage from hepaticojejunoanastomosis is associated with biliary wall weakness. The use of minimally invasive technologies is effective in the treatment of early biliary complications after pancreaticoduodenectomy. Prevention of early biliary complications after pancreaticoduodenectomy includes precision surgical technique, selection of adequate suture material and assessment of all risk factors for their occurrence.