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

• Published in: Surgery today (Tokyo, Japan) Vol. 51; no. 7; pp. 1212 - 1219
• Main Authors: Nagakawa, Yuichi, Kozono, Shingo, Takishita, Chie, Osakabe, Hiroaki, Nishino, Hitoe, Nakagawa, Naoya, Suzuki, Kenta, Hayashi, Yutaka, Ishizaki, Tetsuo, Katsumata, Kenji, Tsuchida, Akihiko
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.07.2021
• Subjects: Medicine; Medicine & Public Health; Original Article; Surgery; Surgical Oncology; Recurrent cholangitis; Biliary stricture; Laparoscopic pancreaticoduodenectomy; Late complication; Hepatojejunostomy
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-020-02223-z

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.