Advertisement

Langenbeck's Archives of Surgery

, Volume 403, Issue 8, pp 959–966 | Cite as

Short- and long-term outcomes of choledochojejunostomy during pancreaticoduodenectomy and total pancreatectomy: interrupted suture versus continuous suture

  • Takaaki Tatsuguchi
  • Hidenori Takahashi
  • Hirofumi Akita
  • Shogo Kobayashi
  • Akira Tomokuni
  • Kunihito Gotoh
  • Hidetoshi Eguchi
  • Hiroaki Ohigashi
  • Yoshitomo Yanagimoto
  • Norikatsu Miyoshi
  • Keijiro Sugimura
  • Jeong-Ho Moon
  • Takeshi Omori
  • Masayoshi Yasui
  • Hiroshi Miyata
  • Masayuki Ohue
  • Yoshiyuki Fujiwara
  • Masahiko Yano
  • Masato Sakon
  • Osamu Ishikawa
ORIGINAL ARTICLE
  • 76 Downloads

Abstract

Purpose

Choledochojejunostomy can be performed with either interrupted sutures (IS) or continuous sutures (CS). No reports have compared the short- or long-term patient outcomes resulting from these two methods.

Methods

A total of 228 consecutive patients who underwent pancreaticoduodenectomy or total pancreatectomy were prospectively enrolled in this study. All patients were alternately (by turns) assigned to the IS and CS groups. Among those patients, 161 patients who received regular postoperative follow-up for more than 2 years were eligible for analysis (IS group, n = 81; CS group, n = 80). A comparative analysis was performed between these groups regarding short-term (e.g., anastomotic leakage) and long-term complications (e.g., anastomotic stricture), time required to complete the anastomosis, and cost.

Results

The incidence of anastomotic leakage and anastomotic stricture was comparable between the IS and CS groups (1.2% vs. 1.2%, p = 0.993; 8.6% vs. 6.2%, p = 0.563). The groups did not differ regarding the incidence of any short- or long-term complications. The time required to complete the anastomosis in the IS group was 27.0 ± 6.6 min, compared with 16.2 ± 5.0 min in the CS group (p < 0.001). The cost was $144.7 ± 34.6 in the IS group vs. $11.7 in the CS group (p < 0.001).

Conclusions

The IS and CS groups did not differ regarding short- and long-term outcomes. The anastomosis was completed in significantly less time in the CS group. The CS method was also superior in terms of cost.

Keywords

Anastomotic strictures Choledochojejunostomy Continuous sutures Interrupted sutures 

Notes

Acknowledgements

The authors thank the member of Administrative Offices at the Department of Surgery, Osaka International Cancer Institute, for their unfailing enthusiasm and support to our program.

Authors’ contributions

Authorship H.T., H. E.,H. O., M. S., and O. I. participated in study conception and design; T. T., H. T., H. A., S. K., A. T., K. G., H. E., and H. O. participated in acquisition of data; T. T., H. T., H. M., M. O., Y. F., and M. Y. participated in analysis and interpretation of data; T. T., H. T., and H. E. participated in drafting of manuscript; Y. Y., N. M., K. S., J.-H. M., T. O., and M. Y. participated in critical revision of manuscript.

Funding

The present study was partly financially supported by the grant of The Osaka Foundation for The Prevention of Cancer and Life-style Related Diseases for Hidenori Takahashi.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–257 discussion 257-260CrossRefGoogle Scholar
  2. 2.
    Antolovic D, Koch M, Galindo L, Wolff S, Music E, Kienle P, Schemmer P, Friess H, Schmidt J, Buchler MW, Weitz J (2007) Hepaticojejunostomy--analysis of risk factors for postoperative bile leaks and surgical complications. J Gastrointest Surg 11:555–561.  https://doi.org/10.1007/s11605-007-0166-3 CrossRefGoogle Scholar
  3. 3.
    Blankensteijn JD, Terpstra OT (1990) Early and late results following choledochoduodenostomy and choledochojejunostomy. HPB Surg 2:151–158CrossRefGoogle Scholar
  4. 4.
    DiFronzo LA, Egrari S, O’Connell TX (1998) Safety and durability of single-layer, stentless, biliary-enteric anastomosis. Am Surg 64:917–920Google Scholar
  5. 5.
    House MG, Cameron JL, Schulick RD, Campbell KA, Sauter PK, Coleman J, Lillemoe KD, Yeo CJ (2006) Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 243:571–578.  https://doi.org/10.1097/01.sla.0000216285.07069.fc CrossRefGoogle Scholar
  6. 6.
    Panis Y, Fagniez PL, Brisset D, Lacaine F, Levard H, Hay JM (1993) Long term results of choledochoduodenostomy versus choledochojejunostomy for choledocholithiasis. The French Association for Surgical Research. Surg Gynecol Obstet 177:33–37Google Scholar
  7. 7.
    Stapleton GN, Williamson RC (1996) Proximal pancreatoduodenectomy for chronic pancreatitis. Br J Surg 83:1433–1440CrossRefGoogle Scholar
  8. 8.
    Suzuki H, Shimura T, Mochhida Y, Wada S, Araki K, Kubo N, Watanabe A, Kuwano H (2014) To stent or not to stent Hepaticojejunostomy--analysis of risk factors for postoperative bile leaks and surgical complication. Hepatogastroenterology 61:920–926Google Scholar
  9. 9.
    Tocchi A, Mazzoni G, Liotta G, Lepre L, Cassini D, Miccini M (2001) Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease: a follow-up study of more than 1,000 patients. Ann Surg 234:210–214CrossRefGoogle Scholar
  10. 10.
    Zafar SN, Khan MR, Raza R, Khan MN, Kasi M, Rafiq A, Jamy OH (2011) Early complications after biliary enteric anastomosis for benign diseases: a retrospective analysis. BMC Surg 11:19.  https://doi.org/10.1186/1471-2482-11-19 CrossRefGoogle Scholar
  11. 11.
    Ammori BJ, Joseph S, Attia M, Lodge JP (2000) Biliary strictures complicating pancreaticoduodenectomy. Int J Pancreatol 28:15–21 discussion 21-12CrossRefGoogle Scholar
  12. 12.
    Hirano S, Tanaka E, Tsuchikawa T, Matsumoto J, Shichinohe T, Kato K (2012) Techniques of biliary reconstruction following bile duct resection (with video). J Hepatobiliary Pancreat Sci 19:203–209.  https://doi.org/10.1007/s00534-011-0475-5 CrossRefGoogle Scholar
  13. 13.
    Castaldo ET, Pinson CW, Feurer ID, Wright JK, Gorden DL, Kelly BS, Chari RS (2007) Continuous versus interrupted suture for end-to-end biliary anastomosis during liver transplantation gives equal results. Liver Transpl 13:234–238.  https://doi.org/10.1002/lt.20986 CrossRefGoogle Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  15. 15.
    Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic S (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591.  https://doi.org/10.1016/j.surg.2016.11.014 CrossRefGoogle Scholar
  16. 16.
    Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Buchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768.  https://doi.org/10.1016/j.surg.2007.05.005 CrossRefGoogle Scholar
  17. 17.
    Kadaba RS, Bowers KA, Khorsandi S, Hutchins RR, Abraham AT, Sarker SJ, Bhattacharya S, Kocher HM (2017) Complications of biliary-enteric anastomoses. Ann R Coll Surg Engl 99:210–215.  https://doi.org/10.1308/rcsann.2016.0293 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Takaaki Tatsuguchi
    • 1
  • Hidenori Takahashi
    • 1
  • Hirofumi Akita
    • 1
  • Shogo Kobayashi
    • 1
    • 2
  • Akira Tomokuni
    • 1
  • Kunihito Gotoh
    • 1
    • 2
  • Hidetoshi Eguchi
    • 2
  • Hiroaki Ohigashi
    • 3
  • Yoshitomo Yanagimoto
    • 1
  • Norikatsu Miyoshi
    • 1
  • Keijiro Sugimura
    • 1
  • Jeong-Ho Moon
    • 1
  • Takeshi Omori
    • 1
  • Masayoshi Yasui
    • 1
  • Hiroshi Miyata
    • 1
  • Masayuki Ohue
    • 1
  • Yoshiyuki Fujiwara
    • 1
  • Masahiko Yano
    • 1
  • Masato Sakon
    • 1
  • Osamu Ishikawa
    • 1
  1. 1.Department of SurgeryOsaka International Cancer InstituteOsakaJapan
  2. 2.Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversityOsakaJapan
  3. 3.Department of SurgerySocial Welfare Organization Saiseikai Imperial Gift Foundation Senri-HospitalOsakaJapan

Personalised recommendations