Continuous suture of Biliary-enteric anastomosis safe and faster compared with interrupted suture

A new study by Lena Seifert and team showed that compared to interrupted suture, biliary-enteric anastomosis (BEA) continuous suture is quicker and similarly safe. The findings of this study were published in British Journal of Surgery.

Although either continuous suture or interrupted suture methods can be used to conduct biliary-enteric anastomosis, there is insufficient high-quality information to support the superiority of either method. In order to assess the suture procedures for patients undergoing BEA, this study was undertaken by examining the suture time as well as short- and long-term biliary problems.

Patients scheduled for an elective open surgery with a BEA between January 21, 2016, and September 20, 2017, were randomly assigned in a 1:1 ratio to have the BEA done using either the interrupted suture method (ISG) or the continuous suture technique (CSG). The main result was the length of time needed to perform the anastomosis. Secondary outcomes included morbidity and death up to day 30 following the intervention, survival, and BEA-associated postoperative sequelae with and without operational revision of the BEA, including bile leakage, cholestasis, and cholangitis.

The key findings of this study were:

1. A total of 82 patients were randomly assigned, and 80 of them (39 in ISG and 41 in CSG) got the assigned intervention.

2. Suture duration was greater in the ISG than the CSG (median (interquartile range), 22.4 (15.0-28.0) min versus 12.0 (10.0-17.0) min, OR 1.26, 95% c.i. 1.13 to 1.40; increase of 1 min; P 0.001).

3. There were comparable short- and long-term biliary problems between the groups.

4. Bile leakage was common (6 (14.6%) versus 4 (10.3%), P = 0.738), and it was equivalent between groups.

5. In neither group did anastomotic stenosis develop.

Reference:

Seifert, L., von Renesse, J., Seifert, A. M., Sturm, D., Meisterfeld, R., Rahbari, N. N., Kahlert, C., Distler, M., Weitz, J., & Reissfelder, C. (2023). Interrupted versus continuous suture technique for biliary-enteric anastomosis: randomized clinical trial. In BJS Open (Vol. 7, Issue 1). Oxford University Press (OUP). https://doi.org/10.1093/bjsopen/zrac163