Identification of Risk Factors for Post Operative Bile Leaks Following Hepaticojejunostomy

Background:Hepaticojejunostomy has become an important component of many surgical procedures, including the pancreaticoduodenectomy for benign and malignant neoplasms, liver transplantation, local bile duct resection for choledochal cyst and cancer, surgical palliation of unresectable malignant biliary obstruction, drainage for chronic pancreatitis, repair after bile duct injury and other procedure for miscellaneous disease like stone disease.

Objective: To identify the pre and per operative risk factors for the development of postoperative bile leaks in patients following Hepaticojejunostomy.

Methods: This comparative cross-sectional study was conducted in the Department of Hepatobiliary, Pancreatic & Liver Transplant Surgery, BSMMU, Shahbagh, Dhaka. from September 2022 to August 2023. Before starting this study, ethical clearance was taken from the IRB of BSMMU. After considering inclusion exclusion criteria, total of 35 patients undergoing HJ in many surgical procedures were enrolled in this study.

Results: In this study mean BMI of the patients having bile leak were 28.01±1.41 kg/m2 and patients without bile leak were 23.82±3.62 kg/m2 respectively which was statistically significant (p = 0.002). In our study 51.4% of the patients were classified as ASA I where as 48.6% as ASA II. In bile leaks group I, 7 patients were under ASA II.

Conclusion: Patients with poor general condition like over weight (BMI 25-29.9KG/M2), ASA II who underwent PBD, develop polymicrobial growth with commonly used antibiotic resistant organism in bile and disrupted biliary epithelium. These patients are prone to develop postoperative bile leaks following hepaticojejunostomy.