Incidence and risk factors for anastomotic stenosis of continuous hepaticojejunostomy after pancreaticoduodenectomy

Asano, Tomonari; Natsume, Seiji; Senda, Yoshiki; Sano, Tsuyoshi; Matsuo, Keitaro; Kodera, Yasuhiro; Hara, Kazuo; Ito, Seiji; Yamao, Kenji; Shimizu, Yasuhiro

doi:10.1002/jhbp.385

Cited by 38 publications

(32 citation statements)

References 23 publications

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“…At present, Roux-en-Y CJS is the most commonly used method for bile duct reconstruction in the clinical setting (16,17). However, regardless of the type of CJS, because of the deprecation of the sphincter of Oddi, the problem of intestinal fluid reflux cannot be solved completely, and repeated cholangitis stimulation will cause scar tissue hyperplasia and eventually lead to anastomotic stricture, and even cancer (18)(19)(20). Therefore, determining the characteristics of scar formation in CJS is of significance for the prevention and treatment of CJS strictures.…”

Section: Discussionmentioning

confidence: 99%

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Lyu¹,

Wang²,

Zhou³

et al. 2021

Ann Transl Med

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Background:The present study aimed to analyze the scar formation mechanism following Roux-en-Y choledochojejunostomy (CJS) in a novel rat model of obstructive jaundice. Methods:The biliary obstruction model of Sprague-Dawley (SD) rats was established in advance, and 24 rats were randomly divided into 4 groups (control group, 1-day ligation group, 3-day ligation group, and 5-day ligation group). Changes in postoperative weight, common bile duct diameter, and laboratory indexes were analyzed to determine the best operation time. Roux-en-Y CJS in rats was studied based on the model, and the rats were randomly divided into 4 groups [control group, 3-day choledochojejunostomy (CJS) group, 7-day CJS group, and 30-day CJS group]. The same indexes were analyzed, and the characteristics of scar formation were evaluated by histopathology and polymerase chain reaction examination.Results: The third day after common bile duct ligation is the best time for a Roux-en-Y CJS. The common bile duct diameter expands to 4.2 mm on average, and these physiological characteristics are consistent with current standard clinical findings. After completing CJS, the rats' weight returned to normal levels, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), direct bilirubin (DB), and C-reactive protein (CRP) indexes gradually decreased (P<0.05). Anastomotic stoma diameter tended to narrow with time and was significantly narrower on day 30 than preoperation. After CJS, the expression of α-smooth muscle actin (α-SMA) peaked in the early stage and was still higher than that of the control group in the bile duct wall 1 month postoperatively (P<0.05). Transforming growth factor-β1 (TGF-β1) expression gradually increased and was higher than that of the control group at each stage postoperatively (P<0.05). Conclusions:The rat Roux-en-Y CJS model is more in line with our surgical model, and the clinical condition has potential applicability for the study of CJS scar formation. Scar formation following CJS in rats is characterized by the activation of fibroblasts caused by early inflammatory stimulation, which leads to the proliferation of collagen and smooth muscle fibers, resulting in scars.

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Section: Discussionmentioning

confidence: 99%

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Lyu¹,

Wang²,

Zhou³

et al. 2021

Ann Transl Med

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“…Although this is a relatively rare postoperative complication, bile duct leakage can have far-reaching consequences with a high risk of prolonged hospitalization and need for interventional drainage or re-laparotomy, which is associated with high morbidity and mortality, even in high volume centers [ 1 , 2 ]. For the development of anastomotic stenosis, studies report rates between 3.7 and 8.0% [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Continuous or interrupted suture technique for hepaticojejunostomy? A national survey

et al. 2018

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BackgroundHepaticojejunostomy is commonly used in hepato-bilio-pancreatic surgery and a crucial step in many surgical procedures, including pancreaticoduodenectomy. The most frequently used techniques are the interrupted suture and the continuous suture technique. Currently, there is no data available in regard to the utilization of these techniques.MethodsIn total, 102 hospitals in Germany were invited between September and November 2017 to participate in this survey. Using a paper-based questionnaire, data were collected on surgical technique and complication rates of hepaticojejunostomies.ResultsA total of 77 of the 102 addressed hospitals (76%) participated in the survey. On average, each hospital performed 71 hepaticojejunostomies per year - most often in the context of pancreaticoduodenectomy (71%). 24 (31%) hospitals exclusively use an interrupted suture technique, 7 (9%) hospitals solely a continuous suture technique, 3 (4%) hospitals perform a combination of continuous and interrupted suture technique and 43 (56%) hospitals decide on one of both techniques depending on intraoperative findings. According to the participants in this survey, the continuous suture technique is significantly faster than the interrupted suture technique in hepaticojejunostomy (p = 0,015). There were no significant differences in the overall complication rate (p = 0,902) and insufficiency rate (p = 1,000).ConclusionsIn Germany, there is a heterogeneity in the technique used to create a hepaticojejunostomy. As our survey suggests that the use of continuous suture technique may offer an advantage in time without jeopardizing patient outcomes, the different techniques should be compared in a randomized controlled study.

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“…Papillary and biliary stricture are common late complications after endoscopic ampullectomy and pancreaticoduodenectomy procedures, respectively. 33,34 Our findings suggest that these complications may be caused by impared biliary regeneration due to removal of the sphincter of the Oddi-mediated biliary stem cell niche; this highlights the clinical importance of our study. Experiments of DTA-induced ablation of Axin2 þ cells further support the importance of the periampullary microenvironment for maintaining biliary homeostasis.…”

Section: Discussionmentioning

confidence: 64%

Axin2+ Peribiliary Glands in the Periampullary Region Generate Biliary Epithelial Stem Cells That Give Rise to Ampullary Carcinoma

et al. 2021

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Incidence and risk factors for anastomotic stenosis of continuous hepaticojejunostomy after pancreaticoduodenectomy

Abstract: The incidence of HJ stenosis was 8.0%. Close attention would be needed especially for patients at high risk of HJ stenosis, such as high BMI or absence of preoperative biliary stenting.

Cited by 38 publications

References 23 publications

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Continuous or interrupted suture technique for hepaticojejunostomy? A national survey

Axin2+ Peribiliary Glands in the Periampullary Region Generate Biliary Epithelial Stem Cells That Give Rise to Ampullary Carcinoma

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