WE2.7 Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy

Abstract

Abstract Aims To compare outcomes of interrupted (IS) and continuous (CS) suturing techniques for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy. Method s. A systematic search of electronic information sources and bibliographic reference lists were conducted. A combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases was applied. Overall biliary complications, bile leak, biliary stricture, cholangitis, liver abscess, and anastomosis time were the evaluated outcome parameters. Results Nine comparative studies were included which reported 1061 patients of whom 630 patients underwent Roux-en-Y hepaticojejunostomy (IS:281, CS:309) 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:9.82 minutes, p<0.00001) compared to CS, there was no significant difference in overall biliary complications (OR:1.34, p=0.19), bile leak (OR:1.73, p=0.26), biliary stricture (OR:0.77, p=0.64), 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 outcomes although the former may be associated with a longer anastomosis time. 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.