Biodegradable biliary stents in pancreaticoduodenectomy for mitigating biliary complications in high-risk anastomoses

Abstract

BACKGROUND: Biliary complications are a significant challenge in pancreaticoduodenectomy (PD), particularly in patients with small bile ducts. This study evaluated the safety and efficacy of biodegradable biliary stents (BS) in reducing biliary complications and improving outcomes in patients undergoing PD. METHODS: This retrospective study included 80 patients with a high risk of biliary fistula undergoing PD at a single high-volume center. Patients were divided into two groups: those who received a biodegradable biliary stent (BS group, n=40) and a retrospective cohort of patients who underwent biliary anastomosis without a stent (nBS group, n=40). A 1:1 propensity score matching (PSM) was performed based on key clinical and surgical variables to reduce selection bias. The primary outcome was the incidence of biliary fistulas. Cost analysis was also conducted. RESULTS: After PSM, 30 matched pairs were analyzed. The BS group had significantly shorter operative times for robotic biliary anastomosis (14 [12-18] vs. 22 [20-27] minutes, p<0.001). No biliary fistulas occurred in the BS group, compared to 3 cases (10%) in the matched nBS group (p=0.039). Comprehensive Complication Index scores were lower in the BS group (21.2 [0-62] vs. 24 [0-88], p=0.047), suggesting reduced overall morbidity. One early biliary stricture occurred in the BS group and one late stricture in the nBS group. No deaths occurred in the BS group, while one patient (3.3%) died in the nBS group (p=0.317). Cost analysis showed no statistically significant differences but suggested a trend favoring stent use. CONCLUSION: Biodegradable biliary stents reduce biliary fistulas and operative time in PD while demonstrating a favorable safety profile. Early complications such as transient jaundice occurred at low rates, the absence of long-term biliary strictures supports their use as a valuable tool in high-risk biliary anastomoses. Multicenter studies with long-term follow-up are necessary to validate these findings and assess cost-effectiveness.