Title: Early Complications after Biliary Enteric Anastomosis for Benign Diseases: A Retropective Analysis

Background: Biliary-enteric anastomosis (BEA) is a common surgical procedure performed for the management of biliary obstruction or leakage resulting from a variety of benign and malignant disease processes. Complications are frequent and very few studies in the past have investigated associated factors. We aimed to determine the incidence and factors associated with early complications occurring after biliary-enteric anastomosis for a benign disease etiology. Methods: We reviewed the medical records of all patients undergoing biliary-enteric anastomosis for a benign disease at our institution in the last 22 years. The primary outcome was early post operative complications. Multivariate logistic regression analysis was performed to identify factors associated with occurrence of complications. Results: A total of 79 records were reviewed, of which 57% were female. 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, and 19 patients (24%) underwent a choledochojejunostomy; while a choledochoduodenostomy was performed in 26 patients (33%). Early complications occurred in 39 (49%) patients; 41% had surgical complications and 25% had systemic ones. Most frequent complications were wound infection (23%) and biliary leak (10%). Mortality occurred in 4 (5%) patients. Independent factors associated with complications were low albumin levels (OR=16, 95% CI=1.14-234.6) and higher ASA levels (OR=7, 95% CI: 1.2233.34). Conclusions: We report a high rate of complications which may be explained by a high rate of pre-operative hypoalbuminemia in our population. Populations from developing countries may benefit from pre-operative nutritional screening and enhancement.