Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy.
Hajibandeh, Shahin Hajibandeh, Shahab Parente, Alessandro Bartlett, David Chatzizacharias, Nikolaos Dasari, Bobby V M Hartog, Hermien Perera, M Thamara P R Marudanayagam, Ravi Sutcliffe, Robert P
Hajibandeh, Shahin
Hajibandeh, Shahab
Parente, Alessandro
Bartlett, David
Chatzizacharias, Nikolaos
Dasari, Bobby V M
Hartog, Hermien
Perera, M Thamara P R
Marudanayagam, Ravi
Sutcliffe, Robert P
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2022-05-13
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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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Hajibandeh S, Hajibandeh S, Parente A, Bartlett D, Chatzizacharias N, Dasari BVM, Hartog H, Perera MTPR, Marudanayagam R, Sutcliffe RP, Roberts KJ, Isaac JR, Mirza DF. Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy. Langenbecks Arch Surg. 2022 Aug;407(5):1817-1829. doi: 10.1007/s00423-022-02548-y. Epub 2022 May 13
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