Postoperative Cholangitis After Biliary Reconstruction: Risk Factors, Timing of Occurrence, and Validity of Tokyo Guidelines.

Abstract

Postoperative cholangitis (POC) is a major late complication of biliary reconstruction. This study aimed to investigate the risk factors and timing of POC occurrence and the validity of the Tokyo Guidelines 18 (TG18) for POC diagnosis in patients who underwent biliary reconstruction. A retrospective review was conducted on 635 patients who underwent biliary reconstruction between January 2010 and December 2020. The incidence of first-occurrence POC requiring hospitalization was determined. Risk factors were identified using logistic regression analysis. The validity of the original and modified TG18 criteria for POC diagnosis was examined. The incidence of first-occurrence POC was 8.2% in the first year and 13.5% in the second year. No difference was observed in incidence between the surgical procedures. Male sex (OR, 2.22; 95% CI: 1.29-3.82) and preoperative alkaline phosphatase level ≤ 296 IU/L (OR, 1.79; 95% CI: 1.10-2.92) were independent risk factors for POC. The definite diagnosis rate of POC using the original TG18 criteria was low (48.7%) and increased to 66.7% using the modified TG18 criteria, which included transient hepatic attenuation difference and pneumobilia as additional diagnostic imaging findings. No association was observed between positive blood cultures and POC severity using TG18. Male sex and preoperative alkaline phosphatase level ≤ 296 IU/L were independent risk factors for POC. The original TG18 score was unsuitable for diagnosing POC after biliary reconstruction, while the modified TG18 score showed improved sensitivity. However, the diagnostic accuracy of the modified TG18 score requires further verification in prospective studies.