Post-Operative Outcomes of Hepaticojejunostomy for Benign Biliary Diseases

Abstract

Introduction: Roux-en-Y hepaticojejunostomy (HJ) is the standard method of biliary reconstruction for repair of Bile Duct Injuries (BDI) or after choledochal cyst excision. However, Roux-en-Y HJ is associated with post operative morbidities like bile leak and wound infections. The aim of this study was to evaluate the 30 day postoperative outcome of HJ and to analyse the factors associated with postoperative morbidity.

Method: A prospective observational study of 51 patients undergoing Roux-en-Y HJ for benign biliary diseases in the department of Surgical Gastroenterology at Bir Hospital, National Academy of Medical Sciences was conducted from August 2018 to January 2020 after approval from Institutional Review Board (IRB). The primary outcomes analyzed were 30 day postoperative morbidities. Patients were divided into 2 groups – “Group with complications” and “Group without complications.” Data were analyzed descriptically and univariate and multivariate logistic regression analyses were performed to identify factors significantly associated with postoperative morbidities.

Result: Out of 51 patients, 34 (66.7%) were female. There were 32 (62.7%) patients with BDI and 17 (33.3%) patients with choledochal cyst excision. Mean age of the patients was 37.9 ± 15.1 years. Wound infection was the commonest complication, noted in 10 (19.6%) patients, followed by bile leakage in 4 (7.8%) patients. BDI patients had significantly higher rate of complications than non-BDI patients (56.2% vs. 10.5%, p=0.001). On univariate analysis, other significant predictors for postoperative complications were low preoperative serum albumin levels, positive bile culture and use of preoperative stenting. On multivariate analysis, patients undergoing HJ for BDI had significantly higher rate of complications compared to those undergoing HJ for nonBDI indications (odds ratio=13.498; 95% CI=1.525-148.767; p=0.034). Univariate analysis of subgroup of BDI patients showed positive bile culture and higher level of injuries (Strasberg E3, 4 or 5) as significant predictors of complications.

Conclusion: Overall morbidity after HJ was noted in 20 (39.2%) patients and wound infection (19.6%) was the most common postoperative complication. Patients who had HJ for BDI had significantly higher rate of complications compared to HJ for non-BDI indications (56.2% vs. 10.5%, p=0.001). Among BDI patients, positive bile culture and higher Strasberg level of injury were significant predictors of complications.