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Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy

  • Systematic Reviews and Meta-analyses
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Aims

To compare outcomes of interrupted (IS) and continuous (CS) suturing techniques for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy.

Methods

The study protocol was prospectively registered in PROSPERO (registration number: CRD42021286294). A systematic search of MEDLINE, CENTRAL, and Web of Science and bibliographic reference lists were conducted (last search: 14th March 2022). All comparative studies reporting outcomes of IS and CS in hepaticojejunostomy and choledochocholedochostomy were included and their risk of bias was assessed using ROBINS-I tool. Overall biliary complications, bile leak, biliary stricture, cholangitis, liver abscess, and anastomosis time were the evaluated outcome parameters.

Results

Ten comparative studies (2 prospective and 8 retrospective) were included which reported 1617 patients of whom 1186 patients underwent Roux-en-Y hepaticojejunostomy (IS: 789, CS: 397) and the remaining 431 patients underwent duct-to-duct choledochocholedochostomy (IS: 168, CS: 263). Although use of IS for hepaticojejunostomy was associated with significantly longer anastomosis time (MD: 14.15 min, p=0.0002) compared to CS, there was no significant difference in overall biliary complications (OR: 1.34, p=0.11), bile leak (OR: 1.64, p=0.14), biliary stricture (OR: 0.84, p=0.65), cholangitis (OR: 1.54, p=0.35), or liver abscess (OR: 0.58, p=0.40) between two groups. Similarly, use of IS for choledochocholedochostomy was associated with no significant difference in risk of overall biliary complications (OR: 0.92, p=0.90), bile leak (OR: 1.70, p=0.28), or biliary stricture (OR: 1.07, p=0.92) compared to CS.

Conclusions

Interrupted and continuous suturing techniques for Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy seem to have comparable clinical outcomes. The available evidence may be subject to confounding by indication with respect to diameter of bile duct. Future high-quality research is encouraged to report the outcomes with respect to duct diameter and suture material.

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Author information

Authors and Affiliations

  1. Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK

    Shahin Hajibandeh, Alessandro Parente, David Bartlett, Nikolaos Chatzizacharias, Bobby V. M. Dasari, Hermien Hartog, M. Thamara P. R. Perera, Ravi Marudanayagam, Robert P. Sutcliffe, Keith J. Roberts, John R. Isaac & Darius F. Mirza

  2. Department of Hepatobiliary and Pancreatic Surgery, University Hospital of Wales, Cardiff, UK

    Shahab Hajibandeh

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  1. Shahin Hajibandeh
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  2. Shahab Hajibandeh
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Contributions

Shahin Hajibandeh and Shahab Hajibandeh equally contributed to this paper and joined first authorship is proposed.

Corresponding author

Correspondence to Shahin Hajibandeh.

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Appendices

Appendix 1

Search No

Search strategy*

#1

MeSH descriptor: [hepaticojejunostomy] explode all trees

#2

hepaticojejunostomy : TI,AB,KW

#3

MeSH descriptor: [choledochocholedochostomy] explode all trees

#4

choledochocholedochostomy : TI,AB,KW

#5

#1 OR #2 OR #3 OR #4

#6

MeSH descriptor: [interrupted ] explode all trees

#7

interrupted : TI,AB,KW

#8

MeSH descriptor: [continuous] explode all trees

#9

continuous: TI,AB,KW

#10

suture: TI,AB,KW

#11

suturing : TI,AB,KW

#12

#6 OR #7 OR #8 OR #9 OR 10 OR #11

#13

#5 AND #12

  1. *This search strategy was adopted for the following databases: MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL)

Appendix 2. Excluded studies

  1. 1-

    Brunner M, Stockheim J, Krautz C, et al. (2018) Continuous or interrupted suture technique for hepaticojejunostomy? A national survey. BMC Surg. 11;18(1):84.

  2. 2-

    Ando H, Kaneko K, Ono Y, et al. (2011). Biliary reconstruction with wide-interval interrupted suture to prevent biliary complications in pediatric living-donor liver transplantation. J Hepatobiliary Pancreat Sci. 18(1):26-31.

  3. 3-

    Ikegami T, Nishizaki T, Kishikawa K, Nomoto K, Uchiyama H, Ohta R, Hiroshige S, Sugimachi K. Biliary reconstruction in living donor liver transplantation with dye injection leakage test and without stent use. Hepatogastroenterology. 2001 Nov-Dec;48(42):1582-4.

  4. 4-

    Nagakawa Y, Kozono S, Takishita C, et al. (2021) Incidence of anastomotic stricture after hepaticojejunostomy with continuous sutures in patients who underwent laparoscopic pancreaticoduodenectomy. Surg Today. 2021 Jul;51(7):1212-1219.

  5. 5-

    Li G, Yuan L, Yu G, Xu Y, Liu J (2020) A Modified Suture Technique in Hepaticojejunostomy. Med Sci Monit.;26:e921896. doi: 10.12659/MSM.921896. PMID: 32189715.

  6. 6-

    Asano T, Natsume S, Senda Y, et al. (2016) Incidence and risk factors for anastomotic stenosis of continuous hepaticojejunostomy after pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 23:628–635

  7. 7-

    Jafari A, Stoffels B, Kalff JC, Manekeller S. An Improved Suture Technique for Perform Biliary Reconstruction in Orthotopic Liver Transplantation. Ann Transplant. 2016 Jan 14;21:25-9. doi: 10.12659/aot.894692. PMID: 26763574.

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Hajibandeh, S., Hajibandeh, S., Parente, A. et al. Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy. Langenbecks Arch Surg 407, 1817–1829 (2022). https://doi.org/10.1007/s00423-022-02548-y

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