A Retrospective Study of Mechanical Hepaticojejunostomy: Can We Use a Circular Stapler as a Viable and Safe Alternative?

Abstract

Background:  Since the early 1980s, some authors have described the use of mechanical staplers to create anastomosis in biliary surgery. However, the use of these devices did not spread in the following decades, and most centres now make hand-sewn anastomosis. Methods: We gathered information retrospectively about the use of mechanical circular staplers for the development of hepaticojejunostomy at our institution from medical records, surgical registries, and computer aided databases. Results:  Our institution conducted 11 stapled hepaticojejunostomies between 2012 and 2020 for both neoplastic and non-neoplastic diseases. The patient's average age was 74, and there were 5 men and 6 women in the group. The normal bile duct diameter was 19 mm on average prior to surgery. Total bilirubin was 6.95 mg/dL in preoperative blood samples. There were no problems during the procedure.  Minor postoperative complications occurred in two patients (18%) (1 wound dehiscence and 1 episode of melena requiring blood transfusions), but no significant complications occurred.There were no biliary fistulas or anastomotic dehiscence in any of the patients.Within 30 days of surgery, no one dies. The average period of stay after surgery was 13 days. Conclusions: Stapled hepaticojejunostomy appears to be a safe and successful procedure in selected patients, based on our limited experience.