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. 2021 Jul;51(7):1212-1219.
doi: 10.1007/s00595-020-02223-z. Epub 2021 Jan 9.

Incidence of anastomotic stricture after hepaticojejunostomy with continuous sutures in patients who underwent laparoscopic pancreaticoduodenectomy

Yuichi Nagakawa  1 , Shingo Kozono  2 , Chie Takishita  2 , Hiroaki Osakabe  2 , Hitoe Nishino  2 , Naoya Nakagawa  2 , Kenta Suzuki  2 , Yutaka Hayashi  2 , Tetsuo Ishizaki  2 , Kenji Katsumata  2 , Akihiko Tsuchida  2
Affiliations

Incidence of anastomotic stricture after hepaticojejunostomy with continuous sutures in patients who underwent laparoscopic pancreaticoduodenectomy

Yuichi Nagakawa et al. Surg Today. 2021 Jul.

Abstract

Purpose: Laparoscopic hepatojejunostomy (HJ) with continuous sutures is commonly performed in laparoscopic pancreaticoduodenectomy (LPD). This study aimed to investigate the long-term surgical outcomes of HJ in LPD.

Methods: We retrospectively evaluated 103 consecutive patients who underwent pancreaticoduodenectomy via laparoscopic HJ with continuous suturing using multifilament (n = 48) or monofilament-absorbable sutures (n = 47).

Results: During follow-up, anastomotic stricture of HJ was identified in 8 (7.8%) patients via balloon enteroscopy-assisted cholangiography. The median time from surgery to confirmation of stricture formation was 7.6 months (range 3.6-19.4). The incidence of HJ stricture was significantly higher in patients with a thin bile duct (diameter < 6.0 mm) than in those with a thick bile duct (diameter ≥ 6.0 mm) [7/27 (25.9%) vs. 1/76 (1.3%), respectively, p < 0.01]. Similarly, it was significantly higher in the monofilament group than in the multifilament group [7/54 (13.0%) vs. 1/49 (2.0%), respectively, p = 0.04]. In the monofilament suture group, 37.5% of patients with thin bile ducts developed stricture after HJ. A multivariate analysis revealed that a thin bile duct was an independent risk factor for HJ stricture (hazard ratio: 25.3, p < 0.01).

Conclusions: Stricture after laparoscopic HJ using continuous sutures frequently occurs in patients with thin bile ducts, particularly when monofilament-absorbable suture is used.

Keywords: Biliary stricture; Hepatojejunostomy; Laparoscopic pancreaticoduodenectomy; Late complication; Recurrent cholangitis.

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