Early (≤ 1 year) anastomotic complications after laparoscopic and robotic hepaticojejunostomy: initial experience
Wei-Liang Loh1, Xiuting Jiang1,2, Yuxin Guo1
1Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, 20 College Road, Level 5 Academia, Singapore, 169856, Singapore.
Background:
Presently, experience with laparoscopic and robotic bilio-enteric anastomosis (BEA) has been increasing world-wide although widespread adoption remains limited. In this study, we report our initial experience with both these modalities.
Methods:
A retrospective cross-sectional review of a single center prospective database of 130 consecutive laparoscopically and robotically constructed BEAs in hepatopancreatobiliary surgeries performed between 2013 and 2022 was conducted. A propensity-scored match analysis comparing results between both groups was performed.
Results:
There were 55 patients in the laparoscopic cohort and 75 patients in the robotic cohort. There were no significant differences in the demographic data between both groups. Operative time was longer in the robotic group, but with less blood loss. There were no differences between the groups with regards to length of stay, number and grade of complications, reoperation and mortality rates. After propensity-score matching, there remained statistically significant differences in median operative time (robotic 650 min, 550-720 min; laparoscopic 550 min, 485-590 min) and median blood loss (robotic 200mls, 100-300; laparoscopic 300mls, 200-500mls). There remained no differences between the groups with regards to length of stay, number and grade of complications, reoperation and mortality rates between both groups after propensity-score matching. The overall biliary anastomotic leak rate was 4.6% (6/130). The anastomotic leak rate for L-HJ was 9.1% (5/55) versus 1.3% (1/75) for R-HJ, P = 0.08).
Conclusion:
Laparoscopic and robotically constructed bilio-enteric anastomosis can be adopted safely with a low anastomotic complication rate.
