Safety and durability of single-layer, stentless, biliary-enteric anastomosis

Biliary-enteric anastomosis has long been associated with significant complications of early bile leak, cholangitis, and late stricture formation, and controversy exists regarding which operative technique best prevents these problems. Biliary-enteric anastomosis was performed using a single-layer running 4-0 polyglactin (Vicryl) suture, without a transanastomotic stent, in 97 patients by a single surgeon over a 17-year period. Indications for operation included malignant obstruction (84.5%), benign stricture, choledocholithiasis, and choledochal cyst. The most common operation performed was a choledochoduodenostomy; the remaining operations were either Roux-en-Y choledochojejunostomy, hepaticoduodenostomy, or Roux-en-Y hepaticojejunostomy. Complications occurred in 14.1 per cent of patients; there was one perioperative death. There was only one case of anastomotic leak (1%), which resolved spontaneously within 1 week. Mean hospital stay was 8.7 days. The mean follow-up was 13.1 months in all patients. Among patients with benign disorders of the biliary tract, the mean follow-up was 21 months, during which time no patient developed an anastomotic stricture. One patient experienced postoperative cholangitis, although not as a result of anastomotic stricture. Biliary-enteric anastomosis for both benign and malignant disorders can be safely performed using a running, absorbable suture without a stent.