Short- and long-term outcomes of choledochojejunostomy during pancreaticoduodenectomy and total pancreatectomy: interrupted suture versus continuous suture
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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.
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.
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).
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.
KeywordsAnastomotic strictures Choledochojejunostomy Continuous sutures Interrupted sutures
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.
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.
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.
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 was obtained from all individual participants included in the study.
- 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.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
- 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.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.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
- 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
- 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.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