Interrupted versus continuous sutures in the posterior wall of bilioenteric anastomosis: A retrospective study

Abstract

Background: Hepaticojejunostomy (HJ) anastomosis is a vital surgical procedure in gastrointestinal surgery that involves the creation of a connection between the bile duct and the jejunum. This study aimed to evaluate the effectiveness of interrupted suturing, compared with continuous suturing of the posterior wall of the anastomosis, regarding primary and secondary outcomes of HJ anastomosis. Patients and Methods: Sixty patients were allocated to two groups, each group comprising 30 patients where in group A (Interrupted Suture, n=30), 4/0 polydioxanone sutures were used. In group B (continuous Suture, n=30), 4/0 proline sutures were used. In addition, in all cases interrupted sutures 4/0 polydioxanone were used in the anterior wall of anastomosis to decrease postoperative stricture incidence, then all patients were followed up until the end of data analysis (6 months after HJ anastomosis) using a standardized data collection sheet. Results: The primary postoperative outcomes: Regarding the incidence of leakage, the continuous group (13.3%) had a lower rate of postoperative biliary leak than the interrupted group (16.7%). Regarding the incidence of stricture of anastomosis, two (6.7%) cases had strictures in the interrupted group, whereas there were four (13.8%) strictures in the continuous group. This suggests that the interrupted group had a lower risk of postoperative strictures than the continuous group. Regarding secondary outcomes, the mean number of sutures of the posterior wall was six in the interrupted group, while it was two in the continuous group which means the continuous group was better than the interrupted group as regards cost and time consumed during anastomosis. Conclusion: Postoperative outcomes in HJ vary with interrupted and continuous suture techniques. The continuous sutures revealed lower postoperative biliary leakage, and had better time and cost-effectiveness, while the interrupted sutures had lower incidence of stricture formation.