Risk factors for postoperative bile leakage and mortality following bilio-enteric anastomosis: a prospective cohort study.

BACKGROUND

Bilio-enteric anastomosis surgery (BEA) is a critical surgical procedure used to restore bile flow in patients with biliary obstruction or after bile duct resection. Despite its importance, the procedure is associated with complications, such as bile leakage and postoperative mortality. Identifying the risk factors for these complications can enhance the surgical outcomes and patient safety. This study aimed to identify the factors associated with bile leakage and postoperative mortality following BEA.

METHODS

We conducted a prospective cohort study at our department of Hepatobiliary surgery, from November 2020 to April 2022. Data on demographics, preoperative conditions, surgical details, and outcomes were collected. Univariate and multivariate binary logistic regression analyses were used to identify predictors of bile leakage and 90-day mortality.

RESULTS

We included 107 adult patients who underwent BEA. Bile leakage occurred in 28% of the cases, and postoperative mortality rates were 2.8% at 30 days and 4.7% at 90 days. Factors significantly associated with bile leakage included: surgery performed for cancer (OR = 3.661, 95% CI [1.243-10.782], P = 0.019) and blood transfusion (OR = 3.834, 95% CI [1.153-12.750], P = 0.028). Independent predictors of 90-day mortality were preoperative serum total bilirubin levels (OR = 1.095, 95% CI [1.003-1.195], P = 0.042) and postoperative biliary peritonitis (Bile leakage Grade C) (OR = 35.747, 95% CI [3.068-416.5], P = 0.004).

CONCLUSIONS

BEA performed for cancer and blood transfusion are independent factors associated with a higher incidence of bile leakage. In contrast, preoperative bilirubin levels and postoperative biliary peritonitis are independent factors associated with an increased risk of 90-day mortality.