Continuous or interrupted suture technique for hepaticojejunostomy? A national survey

Area of Science:

• Hepatobiliary Surgery
• Surgical Techniques
• Gastrointestinal Surgery

Background:

• Hepaticojejunostomy is a key procedure in hepato-bilio-pancreatic surgery, particularly for pancreaticoduodenectomy.
• The interrupted and continuous suture techniques are most common, but their utilization is not well-documented.
• This study addresses the lack of data on hepaticojejunostomy technique usage in German hospitals.

Purpose of the Study:

• To survey the utilization of different hepaticojejunostomy techniques in German hospitals.
• To compare the efficiency and complication rates of interrupted versus continuous suture techniques for hepaticojejunostomy.

Main Methods:

• A survey was conducted among 102 German hospitals between September and November 2017.
• Paper-based questionnaires collected data on surgical techniques and complication rates for hepaticojejunostomies.
• A response rate of 76% (77 hospitals) was achieved.

Main Results:

• Hospitals performed an average of 71 hepaticojejunostomies annually, primarily for pancreaticoduodenectomy (71%).
• 56% of hospitals utilize techniques based on intraoperative findings, while 31% exclusively use interrupted sutures and 9% exclusively use continuous sutures.
• The continuous suture technique was significantly faster (p=0.015) than the interrupted suture technique, with no significant difference in overall complication or insufficiency rates (p=0.902, p=1.000).

Conclusions:

• Significant heterogeneity exists in hepaticojejunostomy techniques across German hospitals.
• The continuous suture technique may offer a time advantage without compromising patient outcomes.
• A randomized controlled study is recommended to compare the different hepaticojejunostomy techniques.