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Background: Interrupted sutures is the gold standard technique of hepaticojejunostomy (HJ) for bilioenteric anastomosis. This study compares the safety and early complications of continuous and interrupted suture HJ. Methods: A prospective study involving all elective HJ between September 2019 and June 2021 was conducted. Patients with type IV or V biliary strictures, duct diameter less than 8 mm and/or associated vascular injury, and bilateral HJ were excluded. The study patients were divided into two random groups; interrupted and continuous anastomotic technique. Patient demographics, preoperative parameters including pathology (benign vs. malignant), HJ leak, suture time, and postoperative morbidity were recorded. Results: Total 34 patients were enroled. Eighteen (52.9%) were into interrupted and 16 (47.1%) patients into the continuous group. Both the groups were comparable with regards to demographics, haemoglobin, serum albumin, preoperative cholangitis and biliary stenting. Total three (8.8%) patients in the entire study developed bile leak; interrupted-2 and continuous-1, which was not significant statistically (P=1.0). Similarly, total number of sutures used and the mean operating time to complete anastomosis in the continuous group was significantly lesser than the interrupted group (2.3±0.5 versus 9.6±1.6, P<0.001) and (16.2±3.1 versus 38.6±9.2 min, P<0.001), respectively. There were three (18.8%) re-exploration in the continuous anastomotic technique. Among them, only one re-operation was due to HJ anastomosis failure without mortality, remaining had re-exploration for bleeding (non-HJ). Conclusions: Both the techniques is safe with comparable morbidity. Further, continuous has an added advantage of decreased anastomotic time and cost.
RESUMO
Introduction Choledochal cysts (CCs) are uncommon biliary lesions. Considering the evolution of imaging, we describe our experience with the presentation and management of choledochal cysts. Methods A review of the records of all patients with choledochal cyst managed in our institute were retrospectively analyzed. The study analyzed clinical presentation, diagnosis, treatment and postoperative outcomes. Results Between 2015 and 2019, 30 CCs (male/female: 7/23) were operated. We observed more adults compared to children (17 vs. 13). The median age at surgery was 18.5 years (4-67 years). The presentation included abdominal pain (90%), pancreatitis (17%0, cholangitis (13%), and incidental diagnosis in (7%). Anomalous union of the bile duct and the pancreatic duct was seen in 17%. Two patients had synchronous cholangiocarcinoma. The cysts were classified (Todani's): I: 26; IV:3; and V: 1. The patients underwent complete excision of the cyst and Roux-en-Y hepaticojejunostomy - 27; pancreaticoduodenectomy - 1; hepaticoduodenostomy - 1; and cholecystectomy with T-tube drainage - 1 patient. The operative complications were observed in 10 (33.3%) patients: biliary leaks (four), superficial surgical site infections (four), and cholangitis (three). Only one patient developed a major complication; required re-operation for bile leak peritonitis. There was no operative mortality. One patient with cholangiocarcinoma died with the disease at three months of surgery. The remaining 29 patients are doing well at a mean follow-up of 29.5 months (12-56). Conclusion Adults CCs now far outnumber children at the time of presentation. The majority were symptomatic Todani's type I cyst. Complete cyst excision and bilio-digestive anastomosis is the best treatment for type I and IV CCs, thus eliminating the risk of malignancy with an excellent operative outcome.
