Abstract
BackgroundHepaticojejunostomy is commonly used in hepato-bilio-pancreatic surgery and a crucial step in many surgical procedures, including pancreaticoduodenectomy. The most frequently used techniques are the interrupted suture and the continuous suture technique. Currently, there is no data available in regard to the utilization of these techniques.MethodsIn total, 102 hospitals in Germany were invited between September and November 2017 to participate in this survey. Using a paper-based questionnaire, data were collected on surgical technique and complication rates of hepaticojejunostomies.ResultsA total of 77 of the 102 addressed hospitals (76%) participated in the survey. On average, each hospital performed 71 hepaticojejunostomies per year - most often in the context of pancreaticoduodenectomy (71%). 24 (31%) hospitals exclusively use an interrupted suture technique, 7 (9%) hospitals solely a continuous suture technique, 3 (4%) hospitals perform a combination of continuous and interrupted suture technique and 43 (56%) hospitals decide on one of both techniques depending on intraoperative findings. According to the participants in this survey, the continuous suture technique is significantly faster than the interrupted suture technique in hepaticojejunostomy (p = 0,015). There were no significant differences in the overall complication rate (p = 0,902) and insufficiency rate (p = 1,000).ConclusionsIn Germany, there is a heterogeneity in the technique used to create a hepaticojejunostomy. As our survey suggests that the use of continuous suture technique may offer an advantage in time without jeopardizing patient outcomes, the different techniques should be compared in a randomized controlled study.
Highlights
Hepaticojejunostomy is commonly used in hepato-bilio-pancreatic surgery and a crucial step in many surgical procedures, including pancreaticoduodenectomy
Hepaticojejunostomies represent an important step in pancreatic resections, liver resections, liver transplantations and bile duct resections, are used as a palliative procedure for non-resectable tumors of the pancreatic
Since most hepaticojejunostomies are constructed as part of pancreatic surgery and these are more likely to be performed in larger institutions, all hospitals in Germany that treat least 30,000 cases per year were selected for inclusion in this survey
Summary
Hepaticojejunostomy is commonly used in hepato-bilio-pancreatic surgery and a crucial step in many surgical procedures, including pancreaticoduodenectomy. Hepaticojejunostomies represent an important step in pancreatic resections, liver resections, liver transplantations and bile duct resections, are used as a palliative procedure for non-resectable tumors of the pancreatic. Hepaticojejunostomy has been established as an important component of many surgical procedures and all other techniques have been more or less abandoned. The most important complications following a hepaticojejunostomy are bile duct leakage and anastomotic stenosis. In the literature leakage rates after hepaticojejunostomies vary between 2.3 and 5.6% [9, 10] This is a relatively rare postoperative complication, bile duct leakage can have far-reaching consequences with a high risk of prolonged hospitalization and need for interventional drainage or re-laparotomy, which is associated with high morbidity and mortality, even in high volume centers [1, 2]. For the development of anastomotic stenosis, studies report rates between 3.7 and 8.0% [11, 12]
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