Kocaeli Med J. 2021; 10(3): 234-241 | DOI: 10.5505/ktd.2021.62534

Does Hepaticojejunostomy Anastomosis Technique Have an Effect on Bile Fistula Development?

Orhan Aras, Ýsmail Gomcelý
Department Of Gastroenterology Surgery, Antalya Training And Research Hospital, Antalya, Turkey

INTRODUCTION: Early or late complications of bilioenteric anastomoses may bring other problems that are difficult to tackle. We aimed to evaluate the effect of anastomosis technique on the formation of bile fistula seen in this spectrum of complications starting from wound infection to liver failure.
METHODS: Patients who underwent hepaticojejunostomy anastomosis due to periampullary region masses, stomach tumor, biliary tract injury between 2013-2019 were grouped according to the preferred anastomosis method.The interrupted suturing technique was preferred in the main bile duct less than 5mm and morbidly obese patients with a diameter of 5 to 7 mm, whereas in other patients, the continuous anastomosis technique was preferred. In patients using continuous technique, basic sutures were added to the area with bile leakage in anastomosis and included in the combined method group. Postoperative leak rates of patients were compared.
RESULTS: 130 patients underwent hepaticojejunostomy anastomosis. The mean age of the patients was 62, of which 54 were men and 76 were women. According to the anastomosis technique applied, the patients were divided into 3 groups with the names of continuous, interrupted suturing and combined method groups. Bile leakage was observed in 5 of 130 patients. In 4 of these patients, continuous suturing method was used in 1. One patient's bile leak could not be brought under control and he needed surgery again.
DISCUSSION AND CONCLUSION: In the evaluation of our study, there are advantages of continuous hepaticojejunostomy anastomosis in patients with a main bile duct larger than 7 mm, and there was no significant difference between early complications..

Keywords: hepaticojejunostomy, continuous anastomosis technique, bile leak

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Hepatikojejunostomi Anastomoz Tekniðinin Safra Fistülü Geliþiminde Etkisi Var Mý?

Orhan Aras, Ýsmail Gomcelý
Gastroenteroloji Cerrahisi Kliniði, Antalya Eðitim ve Araþtýrma Hastanesi, Antalya, Türkiye

GÝRÝÞ ve AMAÇ: Bilioenterik anastomozlarýn erken ya da geç dönem komplikasyonlarý mücadelesi zor baþka sorunlarý beraberinde getirebilmektedir. Yara yeri enfeksiyonundan baþlayýp karaciðer yetmezliðine kadar uzanan bu komplikasyon yelpazesinde görülen safra fistülünün oluþumunda anastomoz tekniðinin etkisini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: 2013-2019 yýllarý arasýnda periampuller bölge kitleleri, mide tümörü, safra yolu yaralanmasý nedenleri ile hepatikojejunostomi anastomozu uygulanan hastalar tercih edilen anastomoz yöntemine göre gruplandýrýldý. 5 mm den küçük ve 5-7 mm arasýnda ana safra kanalý çapýna sahip morbid obez hastalarda tek tek sütürasyon tekniði, diðer hastalarda ise kontiü anastomoz tekniði tercih edildi. Kontinü teknik kullanýlan hastalarda anastomozda safra sýzýntýsý olan alana tek tek sütürasyonlar eklenip kombine yöntem grubuna alýndý. Hastalarýn postoperatif kaçak oranlarý karþýlaþtýrýldý.
BULGULAR: 130 hastaya hepatikojejunostomi anastomozu uygulandý. Hastalarýn yaþ ortalamasý 62 olup 54’ü erkek, 76’sý kadýnlardan oluþmaktaydý. Uygulanan anastomoz tekniðine göre hastalar kontinü, tek tek sütürasyon ve kombine yöntem gruplarý isimleriyle 3 gruba ayrýldý. 130 hastanýn 5’inde safra kaçaðý görüldü. Bu hastalarýn 4’ünde kontinü 1’inde ise tek tek sütürasyon yöntemi uygulandý. 1 hastanýn safra kaçaðý kontrol altýna alýnamayýp tekrar ameliyat ihtiyacý oldu.
TARTIÞMA ve SONUÇ: Çalýþmamýzýn deðerlendirilmesinde 7 mm den büyük ana safra yoluna sahip hastalarda kontinü hepatikojejunostomi anastomozunun avantajlarý olup, erken dönem komplikasyonlarý arasýnda belirgin fark görülmedi.

Anahtar Kelimeler: hepatikojejunostomi, kontinü anastomoz tekniði, safra kaçaðý

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