The difficult hepaticojejunostomy after pancreatic head resection: reconstruction with a T tube.
BACKGROUND
After pancreatic head resection, bile leaks from a difficult hepaticojejunostomy secondary to a small or fragile common hepatic duct may be reduced by a T tube at the side of the anastomosis.


METHODS
A retrospective analysis of patients who underwent a difficult hepaticojejunostomy without or with a T tube was performed.


RESULTS
In 48% (55/114) of patients, a T tube was placed at the side of the hepaticojejunostomy; 52% (59/114) did not have a T tube. Bile leaks occurred in 12% (14/114) (9% [5/55] in patients with a T tube vs 15% [9/59] without a T tube, P = .316). Bile leaks were associated with mortality, abscess formation, hemorrhage, and sepsis. Seven percent (8/114) of patients required revisional laparotomy (2% [1/55] with a T tube vs 12% [7/59] without a T tube, P = .036). Mortality was not different between the groups. Minor T-tube-associated complications occurred in 15% (8/55) without major complications.


CONCLUSIONS
Augmentation of anastomosis with a T tube cannot prevent biliary leakage but does reduce the severity of bile leaks, resulting in less reoperations.
['Herzog|Torsten|T|', 'Belyaev|Orlin|O|', 'Bakowski|Philipp|P|', 'Chromik|Ansgar M|AM|', 'Janot|Monika|M|', 'Suelberg|Dominique|D|', 'Uhl|Waldemar|W|', 'Seelig|Matthias H|MH|']
D018784:Abdominal Abscess D000714:Anastomosis, Surgical D057868:Anastomotic Leak D001646:Bile D015331:Cohort Studies D004322:Drainage D005260:Female D006470:Hemorrhage D006500:Hepatic Duct, Common D006801:Humans D007582:Jejunostomy D008099:Liver D008297:Male D008875:Middle Aged D010180:Pancreatectomy D010185:Pancreatic Fistula D011183:Postoperative Complications D012086:Reoperation D012189:Retrospective Studies D018805:Sepsis
Hepaticojejunostomy T tube Bile leak Pancreatic surgery