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Open Access Highly Accessed Research article

Early complications after biliary enteric anastomosis for benign diseases: A retrospective analysis

Syed Nabeel Zafar1, Muhammad Rizwan Khan1*, Rushna Raza1, Muhammad N Khan1, Mahwash Kasi2, Ammar Rafiq2 and Omer H Jamy2

Author Affiliations

1 Dertment of Surgery, Aga Khan University, Stadium Road, Karachi - 74800, Pakistan

2 Medical College, Aga Khan University, Stadium Road, Karachi - 74800, Pakistan

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BMC Surgery 2011, 11:19  doi:10.1186/1471-2482-11-19

Published: 25 August 2011

Abstract

Background

Biliary-enteric anastomosis (BEA) is a common surgical procedure performed for the management of biliary obstruction or leakage that results from a variety of benign and malignant diseases. Complications following BEA are not rare. We aimed to determine the incidence and the factors associated with early complications occurring after BEA for benign diseases.

Methods

We reviewed the medical records of all patients who underwent BEA for benign diseases at our institution between January 1988 and December 2009. The primary outcome was early post operative complication. Logistic regression analysis was done to identify factors predicting the occurrence of complications.

Results

Records of 79 patients were reviewed. There were 34 (43%) males and 45 (57% females). Majority (53%) had choledocholithiasis with impacted stone or distal stricture, followed by traumatic injury to the biliary system (33%). Thirty-four patients (43%) underwent a hepaticojejunostomy, 19 patients (24%) underwent a choledochojejunostomy, and choledochoduodenostomy was performed in 26 patients (33%). Early complications occurred in 39 (49%) patients - 41% had local complications and 25% had systemic complications. Most frequent complications were wound infection (23%) and bile leak (10%). Four (5%) patients died. On multivariate analysis, low serum albumin level (odds ratio = 16, 95% CI = 1.14-234.6) and higher ASA levels (odds ratio = 7, 95% CI: 1.22-33.34) were the independent factors predicting the early complications following BEA.

Conclusions

Half of the patients who underwent BEA for benign diseases had complications in our population. This high incidence may be explained by the high incidence of hypoalbuminemia and the high-risk group who underwent operation.