Interrupted Versus Continuous Suture Technique in End-to-End Stentless Biliary Reconstruction

Abstract Background: A wide variety of techniques to restore biliary-enteric continuity after biliary injuries, the biliary tree is most commonly anastomosed to the jejunum; either as (Roux-en-Y or a simple loop anastomosis) or less commonly to the duodenum. The anastomosis may be performed to the bile duct, common hepatic duct, 1st or 2nd order hepatic duct branches, or to the gallbladder. Anastomoses may be performed in an end-to-side or side-to-side fashion, using continuous or interrupted sutures. Stents may be deployed across the anas-tomosis. Aim of Study: Biliary strictures and injuries; present a surgical technical challenge for Hepato-biliary surgeons. High biliary strictures are difficult to treat and re-stenosis rates reported of 10 - 30% following corrective repair, Complication rates; mostly due to inflammation, ischemia and tension at the anastomosis site. A combined prospective and retrospective study to evaluate the outcome of bile duct reconstruction using a continuous and interrupted suture technique for anastomosis. A combined prospective and retrospective study to evaluate the outcome of bile duct reconstruction using a continuous and interrupted suture technique for anastomosis.. Patients and Methods: A total number of 30 patients presented with biliary injuries, biliary strictures or stenosis permitted for surgical interventions in a General Surgical Department of Al-Azhar University Hospitals from February 2015 to May 2019, 15 patients were performed by continuous suture as (Group A), and 15 patents performed by interrupted suture technique as (Group B). Data and Statistical Analysis: Data on our series of bile duct anastomosis with either distal biliary duct or small bowel performed including: Surgical procedure, diagnosis, co-morbidities, peri-operative morbidity, and clinical symptoms after repair, liver function tests and the need for surgical or radiological interventions following surgery were evaluated as a prospectively collected on an institutionally approved electronic database. Non-parametric data were described as median and range and parametric data as average and standard deviation. The outcome measures were assessed: peri-operative morbidity, clinical symptoms after repair, liver function tests and the need for surgical or radiological interventions following surgery.
Results: End-to-ends Biliary reconstruction, Hepatico-, Choledocho jejnostomy anastomoses were performed. In (Group A) 15 patients underwent biliary reconstruction using the continuous suture technique. The median operative time was 140 minutes (range 60-300 minutes). Post-operative morbidity was present in three patients (12.5%), shows post-operative biliary leak, wound sepsis, post-operative fever in sequence. In 14 (98.25%) of the 15 patients, there has been no recurrence of jaundice, cholangitis or biliary dilatation on abdominal ultrasonography and liver function tests improved and have returned to normal without further surgical or radiological intervention. Out of anastomoses, there were two patients in (group A) who developed leakage, and 3 patients who developed a stricture for an incidence of 1.75% and 3.25% respectively. Our overall biliary complication rate was 4%, which is lower than previously reported. Conclusions: A continuous suture technique of biliary anastomoses results in an extremely low incidence of common significant complications.