Pure biliary leak vs. pancreatic fistula associated: non-identical twins following pancreatoduodenectomy.

Abstract

Biliary leak (BL) after pancreatoduodenectomy (PD) may have diffrent severity depending on its association with postoperative pancreatic fistula (POPF). Data of 2715 patients undergoing PD between 2011 and 2020 at two European third-level referral Centers for pancreatic surgery were retrospectively reviewed. These included BL incidences, grading, outcomes, specific treatments, and association with POPF. BL occurred in 6% of patients undergoing PD. Among 143 BL patients, 47% had an associated POPF and 53% a pure BL. Major morbidity (64% vs 36%) and mortality (19% vs 4%) were higher in POPF-associated BL group (allP< 0.01). Day of BL onset was similar between groups (POD 2 vs 3;P = 0.2), while BL closure occurred earlier in pure BL (POD 12 vs 23;P < 0.01). Conservative treatment was more frequent (55% vs 15%;P < 0.01), and the rate of percutaneous and/or trans-hepatic drain placement was lower (30% vs 16%;P = 0.04) in pure BL group. Relaparotomy was more common in POPF-associated BL group (42% VS 17%;P < 0.01) but was performed earlier in pure BL (POD 2 vs 10;P = 0.02). Pure BL represents a more benign entity, managed conservatively in half of the cases.