2019 Volume 34 Issue 4 Pages 150-156
Despite recent improvements in surgical technique and perioperative care, morbidity after pancreatoduodenectomy still remains high. Occasionally, surgeons encounter biliary complications such as cholangitis, bile stricture, hepatolithiasis and pyogenic hepatic abscess. Preoperative endoscopic retrograde cholangiography, which induces changes in the biliary microbiome and bacterial translocation from the bilioenteric anastomosis can cause postoperative cholangitis. Postoperative refractory cholangitis is associated with biliary strictures and hepatolithiasis. Therapeutic options for the biliary strictures include a percutaneous or endoscopic approach, and a surgical reconstruction. As the success and morbidity rate of each therapy are different, clinicians should choose an adequate treatment strategy in each institution. Since pyogenic hepatic abscesses can contribute to a lethal outcome, proper therapeutic management is required for the best results.
