Continuous or interrupted suture technique for hepaticojejunostomy? A national survey

Abstract

BackgroundHepaticojejunostomy is commonly used in hepato-bilio-pancreatic surgery and a crucial step in many surgical procedures, including pancreaticoduodenectomy. The most frequently used techniques are the interrupted suture and the continuous suture technique. Currently, there is no data available in regard to the utilization of these techniques.MethodsIn total, 102 hospitals in Germany were invited between September and November 2017 to participate in this survey. Using a paper-based questionnaire, data were collected on surgical technique and complication rates of hepaticojejunostomies.ResultsA total of 77 of the 102 addressed hospitals (76%) participated in the survey. On average, each hospital performed 71 hepaticojejunostomies per year - most often in the context of pancreaticoduodenectomy (71%). 24 (31%) hospitals exclusively use an interrupted suture technique, 7 (9%) hospitals solely a continuous suture technique, 3 (4%) hospitals perform a combination of continuous and interrupted suture technique and 43 (56%) hospitals decide on one of both techniques depending on intraoperative findings. According to the participants in this survey, the continuous suture technique is significantly faster than the interrupted suture technique in hepaticojejunostomy (p = 0,015). There were no significant differences in the overall complication rate (p = 0,902) and insufficiency rate (p = 1,000).ConclusionsIn Germany, there is a heterogeneity in the technique used to create a hepaticojejunostomy. As our survey suggests that the use of continuous suture technique may offer an advantage in time without jeopardizing patient outcomes, the different techniques should be compared in a randomized controlled study.

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

“…Fourth, the diameter of the bile duct in normal rats is about 1-2 mm, and can dilate to about 5 mm after 3 days of ligation, which can fully meet the needs of CJS. Fifth, CJS follows the clinical method of the continuous posterior wall and the intermittent anterior wall (27), and with practice, we can skillfully master the technique of CJS in rats. Finally, rats' metabolism is fast, the feeding cycle is short, and the scar formation of CJS can be observed 1 month after the operation.…”

The Role of Portoenterostomy with Aggressive Hilar Dissection in Biliary Tract Tumors: Report of Case Series and Review of the Literature

“…They also say that extended left hepatectomy is an independent risk factor for survival [21]. One of the most feared complications of hepaticojejunostomy is bile leakage (0.4-8%) [9,22,23]. Infection, ischemia, edema, applied techniques, and anastomotic tension in the bile ducts that are dissected are the most important causes of bile fistula.…”

“…Some surgeons prefer interrupted sutures in the anterior wall and continuous sutures in the posterior wall, and also some surgeons prefer interrupted sutures for the whole anastomosis. In a large survey study in Germany, it has been reported that both techni ques are equally pr eferable when performing hepaticojejunostomy, and there is no difference in complications [22]. We used an interrupted suture technique in all cases.…”

Mechanical hepaticojejunostomy: can we use a circular stapler as a viable and safe alternative? —a retrospective study of a single center

“…Manual hepaticojejunostomy is classically considered the preferred technique for reconnection of the biliary tree to the digestive tract. The adopted technique for this anastomosis mainly depends on the "surgical school" and expertise of the operating surgeon and can be performed with either continuous or interrupted sutures (2).…”

“…The most common complications that can occur after hepaticojejunostomy are anastomotic leakage or dehiscence with biliary fistula and anastomotic stenosis. Biliary leakage is a short-term complication and can occur in 2.5-5% of cases (2), resulting in prolongation of hospital stay and need for further therapeutic procedures. Instead, anastomotic stricture, due to cicatricial stenosis or local recurrence in case of neoplastic disease is a late presenting complication, that manifests as jaundice, recurrent bile ducts lithiasis or cholangitis.…”