Multi center experience of interrupted versus continuous parachuting suturing technique of hepatico-jejunostomy posterior layer anastomosis
Keywords:
Hepatico-jejunostomy, Biliary enteric anastomosis, continuous or interrupted suturesAbstract
Background: In Biliary enteric anastomosis procedures, hepatico-jejunostomies are a crucial step. Depending on the situation, the hepatico-jejunostomy operation procedure varies depending on the surgical school, and can be continuous or interrupted. Patients and Methods: A prospective comparative randomized study included 100 Patients complaining of malignant pancreatic tumour (65%), iatrogenic bile duct injury (20%), multiple common bile duct stones (10%) and liver transplantation of cirrhotic patients (5%) underwent hepatico-jejunostomy anastomosis to review a multi-center experience of hepatico-jejunostomy anastomosis in Theodor Bilharz Research Institute and Faculty of Medicine of Cairo University with regard to the types of anastomosis performed, early and late complications, and long-term patency and outcomes. Results: According to the type of suturing technique, hepatico-jejunostomy anastomosis patients are sub grouped into posterior interrupted sutures group A and posterior parachuting sutures group B. A significant direct correlation of leakage in group A with obstructive jaundice (r = 0.327 and p value = 0.02), CBD diameter (r = 0.408 and p value = 0.001), and Duct wall thickness (r = 0.408 and p value = 0.001) While there were inverse correlations with pre-operative stent (r = -0.375 and p value = 0.01).
Downloads
References
Akamatsu N., Sugawara Y. and Hashimoto D. (2011). Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors and outcome. Transpl. Int., 24:379–92.
Antolovic D., Koch M., Galindo L., Wolff S., Music E., Kienle P., Schemmer P., Friess H., Schmidt J., Büchler M.W. and Weitz J. (2007). Hepaticoje junostomy--analysis of risk factors for postoperative bile leaks and surgical complications. J. Gastrointest Surg. ,11: 555–61.
Asano T., Natsume S., Senda Y., Sano T., Matsuo K., Kodera Y., Hara K., Ito S., Yamao K. and Shimizu Y. (2016). Incidence and risk factors for anastomotic stenosis of continuous hepatico jejunostomy after pancreatico duodenectomy. J. Hepatobiliary Pancreat. Sci., 23: 628–635.
Bruuner M., Stockheim J., Krautz C., Raptis D., Kersting S., Weber G.F., Grutzmann R. (2018). Continuous or interrupted suture technique for hepatico jejunostomy? A national survey. BMC Surg. 2018 Oct 11; 18:84.
Burkhart R.A., Relles D., Pineda D.M. (2013). Defining treatment and outcomes of hepatico jejunostomy failure following pancreatico-duodenectomy. J. Gastrointest Surg. 451–460.
Chok K.S., Ng K.K. and Poon R.T. (2009). Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br. J. Surg. 2009; 96: 81–7.
Dimou, F. M., Adhikari, D., Mehta, H. B. and Olino K. (2011). Incidence of hepatico-jejunostomy stricture after hepatico-jejunostomy. Surgery, 1–8.
Duconseil P., Turrini O., Ewald J., Berdah S.V, Moutardier V. and Delpero J.R. (2014). Biliary complications after pancreatico duodenectomy: skinny bile ducts are surgeon’s enemies. World J. Surg. ,38:2946–51.
House M.G., Cameron J.L., Schulick R.D., Campbell K.A., Sauter P.K., Coleman J. (2006). Incidence and outcome of biliary strictures after pancreaticoduo denectomy. Ann. Surg., 243:571
Kadaba R.S., Bowers K.A., Khorsandi S., Hutchins R.R., Abraham A.T., Sarker S.J., Bhattacharya S. and Kocher H.M. (2017). Complications of biliary-enteric anastomoses. Ann R CollSurg Engl., 99: 210–5.
Kasahara M., Egawa H., Takada Y., Oike .F, Sakamoto S., Kiuchi T., Yazumi S., Shibata T., Tanaka K. (2006). Biliary reconstruction in right lobe living-donor liver transplantation: comparison of different techniques in 321 recipients. Ann. Surg. 243:559 –66.
Klaiber U., Probst P., Knebel P., (2015). Meta-analysis of complication rates for single-loop versus dual-loop (Roux-en-Y) with isolated pancreatico jejunostomy reconstruction after pancreatico duodenectomy. Br. J. Surg., 102:331–340.
Koch M., Garden O.J., Padbury R. (2011). Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery, 149:680–688.
Linke R., Ulrich F., Bechstein W.O., and Schnitzbauer A.A. (2015). The White-test helps to reduce biliary leakage in liver resection: a systematic review and meta-analysis. Ann. Hepatol., 14:161–167.
- Mercado M.A., Vilatobá M. and Chan C. (2009). Intrahepatic bilioenteric anastomosis after biliary complications of liver transplantation: operative rescue of surgical failures. World J. Surg., 33:534–538.
Olthof P.B., Coelen R.J.S. and Wiggers J.K., (2016). External biliary drainage following major liver resection for perihilarch olangiocarcinoma: impact on development of liver failure and biliary leakage. HPB (Oxford), 18: 348–353
Orii, T., Inan, S., and Hospital, G. (2018). Technical Procedures Causing Biliary Complications after Hepaticojejunostomy in Pancreatico duodenectomy. April.
Pottakkat B., Vijayahari R., Prakash A., Singh R.K., Behari A. and Kumar A. (2010). Factors predicting failure following high bilio-enteric anastomosis for post-cholecystectomy benign biliary strictures. J. Gastrointest Surg., 14: 1389-94.
Soejima Y., Taketomi A., Yoshizumi T., Uchiyama H., Harada N., Ijichi H., Yonemura Y., Ikeda T., Shimada M., Maehara Y. (2006). Biliary strictures in living donor liver transplantation: incidence, management, and technical evolution. Liver Transpl., 12: 979 –86.
Tarantino I., Amata M. and Cicchese N. (2019). Sequential multistenting protocol in biliary stenosis after liver transplantation: a prospective analysis. Endoscopy, 51:1130-5
Wellner, U. F. (2017). Leakage of Hepaticojejunal Anastomosis: Reoperation. https://doi.org/10.1159/000471909.
Published
How to Cite
Issue
Section
Copyright (c) 2022 International journal of health sciences

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.








