Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
Division of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy.
HPB (Oxford). 2022 Oct;24(10):1738-1747. doi: 10.1016/j.hpb.2022.05.005. Epub 2022 May 17.
This study aims to describe the technique and the results of double-layer continuous suture hepaticojejunostomy (HJ) following pancreatoduodenectomy (PD) and total pancreatectomy (TP).
A prospectively maintained database was analyzed retrospectively to identify incidence and severity of biliary leaks (BL) (ISGLS definition), as well as of HJ stenosis (HJS), cholangitis, and need for redo-HJ (in patients with a follow-up ≥3 years) in a consecutive series of 800 procedures (PD = 603; TP = 197). Predictors of biliary complications were also identified.
BLs occurred in 5 patients (0.6%), including 2 (0.3%) combined pancreatic and biliary leaks. Rates of HJS, cholangitis, and need for redo-HJ were 6.1%, 5.4%, and 2.0%, respectively. Incidence of BL was 0.6% in open procedures (4/587) and 0.4% in robotic operations (1/213). Incidence of late biliary complications was also equivalent in open and robotic procedures. Occurrence of BL was predicted by ASA IV status and duodenal cancer, HJS by any associated vascular procedure and hepatic duct size < 8 mm, cholangitis by any associated vascular procedure and normal bilirubin/hepatic enzymes, and redo HJ by history of cholecystectomy and neuroendocrine tumor/cancer.
Double layer continuous suture HJ is associated with low BL rates, and an acceptable incidence of late complications.
本研究旨在描述胰十二指肠切除术（PD）和全胰切除术（TP）后双层连续缝合胆肠吻合术（HJ）的技术和结果。
回顾性分析前瞻性维护的数据库，以确定胆管漏（BL）（ISGLS 定义）的发生率和严重程度，以及 HJ 狭窄（HJS）、胆管炎和需要再次进行 HJ（在随访≥3 年的患者中）在连续 800 例手术（PD=603；TP=197）中的发生率。还确定了胆道并发症的预测因素。
5 例（0.6%）患者发生 BL，其中 2 例（0.3%）为胰胆管联合漏。HJS、胆管炎和需要再次 HJ 的发生率分别为 6.1%、5.4%和 2.0%。开放手术 BL 发生率为 0.6%（4/587），机器人手术 BL 发生率为 0.4%（1/213）。开放和机器人手术的迟发性胆道并发症发生率也相当。BL 的发生与 ASA IV 状态和十二指肠癌有关，HJS 与任何相关的血管手术和肝管直径<8mm 有关，胆管炎与任何相关的血管手术和正常胆红素/肝酶有关，再次 HJ 与胆囊切除术和神经内分泌肿瘤/癌症的病史有关。
双层连续缝合 HJ 与低 BL 发生率和可接受的迟发性并发症发生率相关。
