The efficacy of intraoperative external biliary drainage tubes for late benign biliary strictures in hepaticojejunostomy after pancreaticoduodenectomy.

PURPOSE: This study aimed to investigate the impact of an intraoperative external biliary drainage (EBD) tube on late benign biliary anastomotic strictures (BAS) after pancreaticoduodenectomy (PD).

METHODS

Between 2011 and 2020, 209 patients who underwent PD, including 39 patients with an EBD tube placed in a hepaticojejunostomy (H-J) during surgery (EBD group) and 170 patients without EBD (no-EBD group), were enrolled. Clinical data and the incidence of BAS were compared between the groups.

RESULTS

Thirty-four patients (16%) developed BAS, with a median interval of 5.6 months. Although the incidence of BAS was not significantly different, that of bile leakage (BL) was significantly lower in the EBD group (0% vs. 5%, p = 0.05). On multivariate analysis, a common hepatic duct (CHD) diameter < 7 mm and alkaline phosphatase (ALP) > 500 IU/L three months after surgery were independent risk factors for BAS. In patients with CHD diameter < 7 mm, the incidence of BL, BAS, and after PD was significantly lower in the EBD group, whereas there was no difference between the two groups in patients with CHD diameter ≥ 7 mm.

CONCLUSION

In patients with CHD diameter < 7 mm, an EBD tube should be placed in the H-J during PD.