To Stent or Not To Stent Hepaticojejunostomy--Analysis of Risk Factors for Postoperative Bile Leaks and Surgical Complication.

Background/aims: Hepaticojejunostomy (HJ) has remained an important component of many surgical procedures. Biliary leaks after HJ represent a major complication carrying a high risk for prolonged hospital stay, biliary peritonitis, and the need for placing interventional drains or even conducting a re-laparotomy. The aims of this study were to define predictive factors associated with the incidence of bile leaks and to compare the results of anastomotic stenting of HJ with those obtained without stenting.

Methodology: A retrospective study was performed on patients who underwent HJ between January 2000 and December 2010 at Gunma University Hospital, Department of Surgery I. A bile leak was defined as a bilirubin concentration in the drains exceeding serum bilirubin or occurrence of a biloma requiring drainage. Transanastomotic techniques for HJ were compared between the stented (external diverting stent, internal stent) and non-stented groups with respect to bile leaks.

Results: An HJ leak was demonstrated in 15 patients (12.4%); the overall surgical morbidity was 29.2%. The incidence of clinically relevant bile leaks after HJ was significantly associated with simultaneous liver resection, preoperative biliary drainage (PBD) and the placement of stents through the anastomosis.

Conclusions: We conclude that the routine use of a biliary stent is not justified before and after surgery. We consider that stenting is unnecessary when a full anastomosis of the bile duct to the jejuna mucosa is performed. However, when an anastomosis of the intrahepatic bile duct to the jejuna mucosa is performed, more careful method must be exercised during an anastomotic procedure.