Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Preventive effect of jejunal limb decompression on early-onset postoperative cholangitis after pancreaticoduodenectomy: a propensity score-matched study.
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Kukita Kazuharu, Imamura Masafumi, Yoshida Eiji, Kato Toru, Murakami Takeshi, Kyuno Daisuke, Koyama Masayuki, Kimura Yasutoshi
Аннотация
BACKGROUND: Jejunal limb (JL) peristalsis may affect recovery at reconstructed sites after pancreatobiliary reconstruction in pancreaticoduodenectomy. This study aimed to investigate the effect of JL peristalsis on early-onset postoperative cholangitis and evaluate the prevention effectiveness of JL decompression (JLD).
METHODS: A modified Child reconstruction was performed in 281 patients during pancreaticoduodenectomy. Patients were divided into JLD (n = 210) and non-JLD (n = 71) groups based on the placement of a JLD tube. In the decompression group, the relationship between drainage volume of decompression, a potential surrogate for JL peristalsis, and early-onset postoperative cholangitis was analyzed. Postoperative outcomes were compared between the 2 groups using propensity score matching.
RESULTS: In the JLD group, the drainage volume was significantly higher in patients with early-onset postoperative cholangitis than in those without early-onset postoperative cholangitis (3330 mL [IQR, 1355-7135] vs 770 mL [IQR, 280-1710], respectively; P <.001). Multivariate analysis identified a drainage volume of ≥1555 mL within 14 days after pancreaticoduodenectomy as an independent risk factor for early-onset postoperative cholangitis (odds ratio, 4.91 [95% CI, 2.18-11.10]; P <.001). After propensity score matching, the incidence of early-onset postoperative cholangitis was significantly lower in the decompression group than in the nondecompression group (1.7% vs 20.7%, respectively; P <.003).
CONCLUSION: Impaired JL peristalsis after pancreaticoduodenectomy may be associated with the development of early-onset postoperative cholangitis. The incidence of early-onset postoperative cholangitis is reduced by the placement of a JLD tube.
METHODS: A modified Child reconstruction was performed in 281 patients during pancreaticoduodenectomy. Patients were divided into JLD (n = 210) and non-JLD (n = 71) groups based on the placement of a JLD tube. In the decompression group, the relationship between drainage volume of decompression, a potential surrogate for JL peristalsis, and early-onset postoperative cholangitis was analyzed. Postoperative outcomes were compared between the 2 groups using propensity score matching.
RESULTS: In the JLD group, the drainage volume was significantly higher in patients with early-onset postoperative cholangitis than in those without early-onset postoperative cholangitis (3330 mL [IQR, 1355-7135] vs 770 mL [IQR, 280-1710], respectively; P <.001). Multivariate analysis identified a drainage volume of ≥1555 mL within 14 days after pancreaticoduodenectomy as an independent risk factor for early-onset postoperative cholangitis (odds ratio, 4.91 [95% CI, 2.18-11.10]; P <.001). After propensity score matching, the incidence of early-onset postoperative cholangitis was significantly lower in the decompression group than in the nondecompression group (1.7% vs 20.7%, respectively; P <.003).
CONCLUSION: Impaired JL peristalsis after pancreaticoduodenectomy may be associated with the development of early-onset postoperative cholangitis. The incidence of early-onset postoperative cholangitis is reduced by the placement of a JLD tube.