Suture pitch is important to prevent hepatolithiasis after pancreaticoduodenectomy: a cross-sectional study

Background: Hepatolithiasis is a life-threatening condition, and the incidence of secondary hepatolithiasis has increased in patients with a history of choledochoenterostomy who underwent pancreaticoduodenectomy (PD). In this study, we aimed to evaluate the risk factors and confirm the appropriate treatment for hepatolithiasis after PD. Materials and methods: Between January 2010 and December 2022, 314 patients who underwent PD were evaluated using a cross-sectional study. Eight patients who underwent PD with hepatectomy were excluded, leaving 306 patients for analysis. Patient demographics, surgical factors, and clinical and biochemical parameters were assessed to determine the predictive factors of hepatolithiasis after PD. Results: Among the 306 patients, 21 (6.9%) developed hepatolithiasis after PD. Of these, 17 patients (81.0%) experienced cholangitis, while 4 (19.0%) were asymptomatic. Cholangitis occurred on average 33.4 ± 10.3 months postsurgery. Fifteen patients received treatment (13 with cholangitis, two without). Fourteen underwent balloon enteroscopy-assisted endoscopic retrograde cholangioscopy (BE-ERC), with 100% scope insertion and 87.5% stone removal success rates. Univariate analysis revealed several risk factors for hepatolithiasis after PD, including heavy body weight ( P = 0.0096), high body mass index ( P = 0.0508), benign disease ( P = 0.0109), preoperative drainage ( P = 0.0680), and hepaticojejunostomy suture pitch greater than 2 mm ( P = 0.0222). Multivariate analysis indicated that only a suture pitch greater than 2 mm ( P = 0.0367) was a risk factor for hepatolithiasis after PD. Conclusion: BE-ERC is an effective treatment for hepatolithiasis after PD. For hepaticojejunostomy, the suture pitch should not exceed 2 mm to prevent hepatolithiasis after PD.