Outcomes of double-layer continuous suture hepaticojejunostomy in pancreatoduodenectomy and total pancreatectomy.

Autor:	Napoli N; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy., Kauffmann EF; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy., Caputo R; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy., Ginesini M; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy., Asta F; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy., Gianfaldoni C; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy., Amorese G; Division of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy., Vistoli F; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy., Boggi U; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. Electronic address: u.boggi@med.unipi.it.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2022 Oct; Vol. 24 (10), pp. 1738-1747. Date of Electronic Publication: 2022 May 17.
DOI:	10.1016/j.hpb.2022.05.005
Abstrakt:	Background: This study aims to describe the technique and the results of double-layer continuous suture hepaticojejunostomy (HJ) following pancreatoduodenectomy (PD) and total pancreatectomy (TP). Methods: A prospectively maintained database was analyzed retrospectively to identify incidence and severity of biliary leaks (BL) (ISGLS definition), as well as of HJ stenosis (HJS), cholangitis, and need for redo-HJ (in patients with a follow-up ≥3 years) in a consecutive series of 800 procedures (PD = 603; TP = 197). Predictors of biliary complications were also identified. Results: BLs occurred in 5 patients (0.6%), including 2 (0.3%) combined pancreatic and biliary leaks. Rates of HJS, cholangitis, and need for redo-HJ were 6.1%, 5.4%, and 2.0%, respectively. Incidence of BL was 0.6% in open procedures (4/587) and 0.4% in robotic operations (1/213). Incidence of late biliary complications was also equivalent in open and robotic procedures. Occurrence of BL was predicted by ASA IV status and duodenal cancer, HJS by any associated vascular procedure and hepatic duct size < 8 mm, cholangitis by any associated vascular procedure and normal bilirubin/hepatic enzymes, and redo HJ by history of cholecystectomy and neuroendocrine tumor/cancer. Discussion: Double layer continuous suture HJ is associated with low BL rates, and an acceptable incidence of late complications. (Copyright © 2022 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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