ABSTRACT
INTRODUCTION Biliary-enteric anastomoses are performed for a range of indications and may result in early and late complications. The aim of this study was to assess the risk factors and management of anastomotic leak and stricture following biliary-enteric anastomosis. METHODS A retrospective analysis of the medical records of patients who underwent biliary-enteric anastomoses in a tertiary referral centre between 2000 and 2010 was performed. RESULTS Four hundred and sixty-two biliary-enteric anastomoses were performed. Of these, 347 (75%) were performed for malignant disease. Roux-en-Y hepaticojejunostomy or choledocho-jejunostomy were performed in 440 (95%) patients. Perioperative 30-day mortality was 6.5% (n=30). Seventeen patients had early bile leaks (3.7%) and 17 had late strictures (3.7%) at a median of 12 months. On univariable logistic regression analysis, younger age was a significant risk factor for biliary anastomotic leak. However, on multivariable analysis only biliary reconstruction following biliary injury (odds ratio [OR]=6.84; p=0.002) and anastomosis above the biliary confluence (OR=4.62; p=0.03) were significant. Younger age and biliary reconstruction following injury appeared to be significant risk factors for biliary strictures but multivariable analysis showed that only younger age was significant. CONCLUSIONS Biliary-enteric anastomoses have a low incidence of early and late complications. Biliary reconstruction following injury and a high anastomosis (above the confluence) are significant risk factors for anastomotic leak. Younger patients are significantly more likely to develop an anastomotic stricture over the longer term.
Subject(s)
Bile Duct Diseases/epidemiology , Choledochostomy , Common Bile Duct/surgery , Hepatic Duct, Common/surgery , Postoperative Complications/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Ampulla of Vater , Anastomosis, Surgical , Anastomotic Leak/epidemiology , Bile Duct Neoplasms/surgery , Bile Ducts/injuries , Biliary Tract Surgical Procedures , Carcinoma, Pancreatic Ductal/surgery , Cholangiocarcinoma/surgery , Common Bile Duct Neoplasms/surgery , Constriction, Pathologic/epidemiology , Databases, Factual , Female , Humans , Jejunostomy , Logistic Models , Male , Middle Aged , Mortality , Multivariate Analysis , Odds Ratio , Pancreatic Neoplasms/surgery , Pancreatitis, Chronic/surgery , Retrospective Studies , Tertiary Care Centers , Young AdultABSTRACT
Common causes of chronic upper gastrointestinal bleeding include oesophageal varices, gastroduodenal ulcers and malignancy, and patients mostly present with iron deficiency type anaemia. We present the case of a 60-year-old lady who presented with iron deficiency anaemia and on investigation was found to have a large duodenal polyp requiring surgical excision. On histological examination, the polyp was revealed to be a lipoma. We review the recent literature and formulate a management plan for this rare entity.
