Risk factors of postoperative complications after hepaticojejunostomy for benign biliary diseases / 中华普通外科杂志

ABSTRACT

Objective:To explore the postoperative biliary leakage and severe complication rate and its related risk factors of hepaticojejunostomy (HJ) for biliary disease.Methods:The clinical data of patients undergoing HJ for benign biliary diseases at the First Affiliated Hospital of Anhui Medical University from Jan 2003 to Dec 2017 were retrospectively analyzed. Multi-factor analysis was used to find a risk factor for postoperative bile leakage and severe complications.Results:Two hundred and eighty-three patients received HJ. The median age was 39 years.The short-term complication rate after surgery was 19.1% ( n=54), and the biliary leakage rate was 11.7% ( n=33), and the severe complication rate was 15.2% ( n=43). By multi-factor analysis: preoperative sepsis[ OR=3.875, 95% CI (1.583, 9.485), P=0.003], liver cirrhosis [ OR=3.212, 95% CI (1.001, 10.307), P=0.050], intraoperative blood loss≥400 ml [ OR=6.054, 95% CI (1.231, 29.781), P=0.027],postoperative hospitalization ≥9 days [ OR=6.738, 95% CI (2.287, 19.855), P=0.001] are the independent risk factors for postoperative bile leakage. Main bile duct stone[ OR=2.764, 95% CI (1.174, 6.510), P=0.020], preoperative sepsis [ OR=4.310, 95% CI (1.666, 11.149), P=0.003], intraoperative bleeding ≥400 ml [ OR=5.944, 95% CI (1.231, 29.781), P=0.022] and postoperative hospitalization ≥ 9 days [ OR=11.422, 95% CI (1.317, 49.859), P=0.001] are the independent risk factors for serious complications. Conclusions:HJ should be conducted when the sepsis was under control and sufficient bile drainage.The patients' condition should be comprehensively and accurately assessed before operation. The indications for partial hepatectomy need to be strictly defined.