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.
Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, California, USA.
L A
LA
DiFronzo
S
S
Egrari
T X
TX
O'Connell
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011098:Polyglactin 910; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D015607:Stents; D015996:Survival Rate; D013536:Suture Techniques
D011098:Polyglactin 910