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Continuous vs. interrupted suturing in hepaticojejunostomy: a comprehensive systematic review and meta-analysis
Ahmed Abdelsamad1,2, Mohammed Khaled Mohammed3, Ibrahim Khalil4
1Surgery Department II, University of Witten/Herdecke, 58455, Witten, Germany. Ahmed6361410@gmail.com.
Langenbeck'S Archives of Surgery
|July 4, 2025
Summary
Continuous suturing in hepaticojejunostomy (HJ) significantly reduces operative time and costs compared to interrupted suturing. This meta-analysis found no increase in complications, offering valuable insights for surgical practice.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Surgical Techniques and Innovation
Background:
- Hepaticojejunostomy (HJ) is a critical reconstruction in upper gastrointestinal, pancreaticoduodenectomy, and Hepaticobiliarypancreatic surgeries.
- The optimal suturing technique for HJ remains debated, impacting operative efficiency, costs, and patient outcomes.
- This meta-analysis addresses the controversy by comparing continuous and interrupted suturing methods.
Purpose of the Study:
- To compare the efficacy and safety of continuous versus interrupted suturing techniques in hepaticojejunostomy (HJ).
- To provide evidence-based recommendations for optimal suturing in complex hepatobiliary and pancreatic surgeries.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials and non-randomized cohort studies.
- Inclusion criteria from PubMed, Embase, and Cochrane Library databases.
- Primary outcomes: anastomotic time and costs; Secondary outcomes: bile leakage, stricture, morbidity, cholangitis, hospital stay, re-exploration. Risk of bias and GRADE assessment were performed.
Main Results:
- Seven studies (1,159 patients) analyzed: 388 continuous, 771 interrupted suturing.
- Continuous suturing significantly reduced anastomotic time (MD = -13.06 min, P < 0.001) and costs (SMD = -4.89, P < 0.001).
- No significant differences were found in bile leakage, anastomotic stricture, overall morbidity, cholangitis, hospital stay, or re-exploration rates.
Conclusions:
- Continuous suturing offers significant advantages in reducing operative time and costs for hepaticojejunostomy.
- The observed benefits are achieved without a statistically significant increase in major complications.
- Clinical relevance of findings should be considered alongside surgeon expertise, institutional factors, and patient specifics; further RCTs are warranted.
