Hepaticojejunostomy using sourjet - reconstructive solution for postoperative biliary strictures

Abstract

Introduction: Hepaticojejunostomy (HJS) has become a standard in biliary reconstructions addressed to benign biliary strictures (BBS). The success of HJS is strongly related to the evolution of suture material and suture application technique. Purpose: The aim of the paper was the study and implementation of a new surgical technique of HJS formation using surjet. Material and methods: The contemporaneous requirements for the biliary-digestive anastomosis have imposed the elaboration in the context of the research, of a new technique of HJS using single layer suture through terminal-lateral surjet (invention patent no. 1274). The study was performed on a lot of 203 patients with BBS. Results: We found the following report of application of the classical technique - 155 (76.35%) compared to the surject - 48 (23.65%), depending on the level of the structure according to the Bismuth classification: type I was 33.3±3.78% compared to 66.7±6.80%; type II - 87.0±2.70% compared to 13.0±4.85%; type III - 66.7±3.78% compared to 33.3±6.80% and for type IV was 86.7±2.73% to 13.3±4.90%. The incidence of immediate complications for HJS with surject was 27.1±6.42%, and for traditional HJS - 36.1±3.86%. The ratio of unfavorable remote results was 17 (34.7%) patients, treated with traditional HJS, compared to 6 (12.5%) patients with HJS through surject. Conclusions: The comparative study of the HJS technique highlighted the safety and efficacy of the developed method, method based on the surjet technique. The surgical trauma was significantly reduced, being more favorable for the targeted tissues in reconstruction and a better tightness combined with lasting.