The Impact Of Substantial Celiac Stenosis On Postoperative Bile Leak After Pancreaticoduodenectomy

Objective To explore the potential risk factors of postoperative bile leak(BL)after pancreaticoduodenectomy(PD),especially to evaluate the impact of substantial celiac stenosis on postoperative BL.Methods Data from 511 patients who underwent a PD procedure in Shanghai Ruijin Hospital from 2013.1.1 to 2015.12.31 were retrospectively collected and their postoperative surgical complications were analyzed.The atherosclerotic celiac stenosis was calculated based on preoperative CT.Substantial celiac stenosis(SCS)was defined as at least 50% of diameter stenosis.Patients with SCS were compared with those without in terms of demographics,postoperative surgical complications and perioperative mortality.Logistic regression analysis was used to explore the predictive risk factors of postoperative BL.Results 37 patients out of 511 were found to have SCS(or to have substantial SMA stenosis when exsisting a variated common hepatic artery arising from SMA).Postoperative BL rate in patients with and without SCS was 27.0% and 2.5% respectively(P< 0.001).Overall 4.3% of 511 patients who underwent PD developed postoperative BL.SCS,older age,ASA score II-IV,coronary history,more blood loss and RBC transfusion in operation,and a smaller common bile duct diameter were significantly associated with BL in univariate analysis.In multivariate analysis,only SCS(OR 8.98,95% CI 2.38-33.90,P = 0.001),older age(OR 1.08,95% CI 1.01-1.15,P = 0.002)and smaller common bile duct diameter(OR 0.79,95% CI 0.69-0.92,P = 0.002)proved to be the independent risk factors of postoperative BL.Conclusions SCS is the independent risk factor of postoperative BL after PD.Other independent risk factors include older age and smaller common bile duct diameter.