Continuous vs. interrupted suturing in hepaticojejunostomy: a comprehensive systematic review and meta-analysis.

IF 1.8 3区医学 Q2 SURGERY

Langenbeck's Archives of Surgery Pub Date : 2025-07-04 DOI:10.1007/s00423-025-03756-y

Ahmed Abdelsamad, Mohammed Khaled Mohammed, Ibrahim Khalil, Zeyad M Wesh, Omar A Ahmed, Ahmed Elsherif, Jawad J F Alqedra, Khaled Ashraf Mohamed, Eslam Elmaghraby, Torsten Herzog, Florian Gebauer

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引用次数: 0

Abstract

Background: Hepaticojejunostomy (HJ) is a crucial reconstructive step in upper gastrointestinal (UGI), pancreaticoduodenectomy (PD), and Hepaticobiliarypancreatic (HBP) surgeries. The optimal suturing technique remains debated, with conflicting evidence regarding operative efficiency, costs, and complications. This meta-analysis compares continuous and interrupted suturing to provide evidence-based recommendations.

Methods: A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane Library. Primary outcomes were anastomotic time and costs, while secondary outcomes included bile leakage, anastomotic stricture, morbidity, cholangitis, hospital stay, and re-exploration rates. A random or fixed-effects model was applied based on heterogeneity. We included randomized controlled trials and non-randomized cohort studies. The risk of bias was assessed using the Cochrane ROB 2 tool, Newcastle-Ottawa Scale (NOS), and MINORS instrument as appropriate. Additionally, the quality of evidence for each outcome was evaluated using the GRADE approach. Sensitivity analyses were performed using the leave-one-out method.

Results: Seven studies (1,159 patients) were included (continuous: 388, interrupted: 771). Continuous suturing significantly reduced anastomotic time (MD = -13.06 min, 95% CI: -17.37 to -8.75, P < 0.001) and costs (SMD = -4.89, 95% CI: -6.10 to -3.67, P < 0.001). However, no significant differences were observed in bile leakage, anastomotic stricture, morbidity, cholangitis, hospital stay, or re-exploration rates (P > 0.05). Sensitivity analyses confirmed these findings.

Conclusion: Continuous suturing reduces anastomotic time by ~ 13 min and costs by ~ $90 without increasing complications. While these differences may be statistically significant, their clinical relevance can vary depending on the surgical context. Surgical choice should consider surgeon expertise, institutional protocols, and patient factors. Further randomized controlled trials are necessary to validate these findings.

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肝空肠吻合术中连续缝合与间断缝合：一项全面的系统回顾和荟萃分析。

背景：肝空肠吻合术（HJ）是上胃肠道（UGI）、胰十二指肠切除术（PD）和肝胆胰（HBP）手术中至关重要的重建步骤。最佳缝合技术仍有争议，关于手术效率、成本和并发症的证据相互矛盾。本荟萃分析比较了连续缝合和间断缝合，以提供循证建议。方法：使用PubMed、Embase和Cochrane图书馆进行系统综述和荟萃分析。主要结局是吻合时间和费用，次要结局包括胆漏、吻合口狭窄、发病率、胆管炎、住院时间和再探查率。基于异质性，采用随机或固定效应模型。我们纳入了随机对照试验和非随机队列研究。偏倚风险评估采用Cochrane ROB 2工具、Newcastle-Ottawa量表（NOS）和未成年人量表（如适用）。此外，使用GRADE方法评估每个结果的证据质量。采用留一法进行敏感性分析。结果：纳入7项研究（1159例患者）（连续研究：388例，中断研究：771例）。连续缝合明显缩短吻合时间（MD = -13.06 min, 95% CI: -17.37 ~ -8.75, P < 0.05）。敏感性分析证实了这些发现。结论：连续缝合可缩短吻合时间约13 min，成本约90美元，且无并发症增加。虽然这些差异可能具有统计学意义，但其临床相关性可能因手术情况而异。手术选择应考虑外科医生的专业知识，机构协议和患者因素。需要进一步的随机对照试验来验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.