Bile Leak after Pancreaticoduodenectomy - Our Experience

Background: Mortality of pancreaticoduodenectomy (PD) has come down but morbidity of PD remains high. pancreaticojejunostomy (PJ) leak is common complication and is well studied but there are very few studies regarding post PD bile leak. Methods: Review of our experience with bile leak after PD over a period of three years. Bile leak was defined as hepaticojejunostomy leak (HJ) if drain fluid amylase was normal. Results: Bile leaks were identified in five out of 46 patients who underwent PD. Two patients had HJ leak only and three had combined HJ/PJ leak. All 3 patients with postoperative pancreatic fistula had main pancreatic duct diameter ?3 mm. All 5 patients had bile duct diameter greater than15 mm and all HJ were done in continuous manner. No patient required reoperation for complications and all were managed conservatively. One patient required angioembolization for pseudo aneurysmal bleeding. There was no mortality during hospital stay but two patients died, one of UGI bleeding and another secondary to sepsis after discharge from hospital on day 14 and day 30. None of the patient developed biliary stricture during follow - up of 21 (18 - 25) months. Conclusion: HJ leak is an uncommon complication of PD. Most patients can be managed with conservative treatment.