Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy

• Published in: Langenbeck's archives of surgery 2022-08, Vol.407 (5), p.1817-1829
• Main Authors: Hajibandeh, Shahin, Hajibandeh, Shahab, Parente, Alessandro, Bartlett, David, Chatzizacharias, Nikolaos, Dasari, Bobby V. M., Hartog, Hermien, Perera, M. Thamara P. R., Marudanayagam, Ravi, Sutcliffe, Robert P., Roberts, Keith J., Isaac, John R., Mirza, Darius F.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Medicine; Medicine & Public Health; Systematic Reviews and Meta-analyses; Thoracic Surgery; Traumatic Surgery; Vascular Surgery
• ISSN: 1435-2451; 1435-2451
• DOI: 10.1007/s00423-022-02548-y

Aims To compare outcomes of interrupted (IS) and continuous (CS) suturing techniques for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy. Methods The study protocol was prospectively registered in PROSPERO (registration number: CRD42021286294). A systematic search of MEDLINE, CENTRAL, and Web of Science and bibliographic reference lists were conducted (last search: 14th March 2022). All comparative studies reporting outcomes of IS and CS in hepaticojejunostomy and choledochocholedochostomy were included and their risk of bias was assessed using ROBINS-I tool. Overall biliary complications, bile leak, biliary stricture, cholangitis, liver abscess, and anastomosis time were the evaluated outcome parameters. Results Ten comparative studies (2 prospective and 8 retrospective) were included which reported 1617 patients of whom 1186 patients underwent Roux-en-Y hepaticojejunostomy (IS: 789, CS: 397) and the remaining 431 patients underwent duct-to-duct choledochocholedochostomy (IS: 168, CS: 263). Although use of IS for hepaticojejunostomy was associated with significantly longer anastomosis time (MD: 14.15 min, p =0.0002) compared to CS, there was no significant difference in overall biliary complications (OR: 1.34, p =0.11), bile leak (OR: 1.64, p =0.14), biliary stricture (OR: 0.84, p =0.65), cholangitis (OR: 1.54, p =0.35), or liver abscess (OR: 0.58, p =0.40) between two groups. Similarly, use of IS for choledochocholedochostomy was associated with no significant difference in risk of overall biliary complications (OR: 0.92, p =0.90), bile leak (OR: 1.70, p =0.28), or biliary stricture (OR: 1.07, p =0.92) compared to CS. Conclusions Interrupted and continuous suturing techniques for Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy seem to have comparable clinical outcomes. The available evidence may be subject to confounding by indication with respect to diameter of bile duct. Future high-quality research is encouraged to report the outcomes with respect to duct diameter and suture material.