Results of double-layer running suture hepatico-jejunostomy in pancreatoduodenectomy and total pancreatectomy

Abstract

Introduction: The purpose of the study was to present the results of double-layer running suture hepatico-jejunostomy performed during pancreatoducodenectomy (PD) and total pancreatectomy (TP) with focus on bile leak (BL) and cholangitis related to anastomotic stricture (C-AS). Methods: A prospectively maintained database was searched retrospectively for BL and C-AS occurring in a consecutive series of PDs and TPs, performed between 2007 and 2019.In all patients HJ was performed using a double-layer running suture of 5/0 or 6/0 polydioxanone. Biliary stents were never used. Incidence of BL was the primary study endpoint. Incidence of C-AS (≥3 episodes/year) was defined in patients with a minimum follow-up period of 3 years. The study aimed also at identifying factors predictive of BL and C-AS by using univariate and multivariate logistic regression. Results: A total of 603 PDs and 197 TPs were performed. Incidence of BL was 0.9% (7/800) in the entire series, 0.63% in PD (5/603) and 1.02% in TP (2/197). BL were caused by HJ insufficiency in 5 patients (0.62%) and by patency Luschka's ducts in 2 patients (0.25%). Patients with HJ-related BL were reoperated (n= 4) or managed by biliary drainage (n= 1). C-AS occurred in 28/284 patients (0.9%). Recurrent cholangitis was diagnosed in 21 patients (7.4%) and was managed by either repeat HJ (n= 13; 4.6%) or percutaneous biliary interventions (n=4; 1.4%). Factors predictive of BL and C-AS were reported in table 1. Conclusion: Double layer running suture HJ is associated with excellent BL rates and acceptable incidence of C-AS.Tabled 1