Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis
Abstract Background There have been few studies of countermeasures against postoperative cholangitis, a serious complication after pancreaticoduodenectomy (PD) that impairs quality of life. Objective To evaluate our recently developed, novel method of choledochojejunostomy with a larger anastomotic...
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | Annals of Gastroenterological Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ags3.12744 |
| _version_ | 1827325646226849792 |
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| author | Nana Kimura Takamichi Igarashi Kenta Murotani Ayaka Itoh Toru Watanabe Katsuhisa Hirano Haruyoshi Tanaka Kazuto Shibuya Isaku Yoshioka Tsutomu Fujii |
| author_facet | Nana Kimura Takamichi Igarashi Kenta Murotani Ayaka Itoh Toru Watanabe Katsuhisa Hirano Haruyoshi Tanaka Kazuto Shibuya Isaku Yoshioka Tsutomu Fujii |
| author_sort | Nana Kimura |
| collection | DOAJ |
| description | Abstract Background There have been few studies of countermeasures against postoperative cholangitis, a serious complication after pancreaticoduodenectomy (PD) that impairs quality of life. Objective To evaluate our recently developed, novel method of choledochojejunostomy with a larger anastomotic diameter, the “T‐shaped anastomosis.” Methods The study included 261 cases of PD. The T‐shaped choledochojejunostomy technique was performed with an additional incision for a distance greater than half the diameter of the bile duct at the anterior wall of the bile duct and the anterior wall of the elevated jejunum. To compensate for potential confounding biases between the standard anastomosis group (n = 206) and the T‐shaped anastomosis group (n = 55), we performed propensity score matching (PSM). The primary endpoint was the incidence of medium‐term postoperative cholangitis adjusted for PSM. Results In the PSM analysis, 54 patients in each group were matched, and the median bile duct diameter measured by preoperative CT was 8.8 mm versus 9.3 mm, the rate of preoperative biliary drainage was 31% versus 37%, the incidence of cholangitis within 1 month before surgery was 9% versus 13%, and the incidence of postoperative bile leakage was 2% versus 2%, with no significant differences. The incidence of medium‐term postoperative cholangitis was 15% versus 4%, and multivariate logistic regression revealed that T‐shaped choledochojejunostomy was an independent predictor of a reduced incidence of cholangitis (odds ratio, 0.17, 95% CI 0.02–0.81; p = 0.024). Conclusions The T‐shaped choledochojejunostomy technique was shown to be effective with a significant reduction in the incidence of medium‐term postoperative cholangitis. Clinical trial identification: UMIN000050990. |
| first_indexed | 2024-03-07T14:32:17Z |
| format | Article |
| id | doaj.art-bc05b2d4afb14f07add589c0337450c7 |
| institution | Directory Open Access Journal |
| issn | 2475-0328 |
| language | English |
| last_indexed | 2024-03-07T14:32:17Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Gastroenterological Surgery |
| spelling | doaj.art-bc05b2d4afb14f07add589c0337450c72024-03-06T03:47:05ZengWileyAnnals of Gastroenterological Surgery2475-03282024-03-018230131110.1002/ags3.12744Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysisNana Kimura0Takamichi Igarashi1Kenta Murotani2Ayaka Itoh3Toru Watanabe4Katsuhisa Hirano5Haruyoshi Tanaka6Kazuto Shibuya7Isaku Yoshioka8Tsutomu Fujii9Department of Surgery and Science, Faculty of Medicine, Academic Assembly University of Toyama Toyama JapanDepartment of Surgery and Science, Faculty of Medicine, Academic Assembly University of Toyama Toyama JapanBiostatistics Center, Graduate School of Medicine Kurume University Kurume JapanDepartment of Surgery and Science, Faculty of Medicine, Academic Assembly University of Toyama Toyama JapanDepartment of Surgery and Science, Faculty of Medicine, Academic Assembly University of Toyama Toyama JapanDepartment of Surgery and Science, Faculty of Medicine, Academic Assembly University of Toyama Toyama JapanDepartment of Surgery and Science, Faculty of Medicine, Academic Assembly University of Toyama Toyama JapanDepartment of Surgery and Science, Faculty of Medicine, Academic Assembly University of Toyama Toyama JapanDepartment of Surgery and Science, Faculty of Medicine, Academic Assembly University of Toyama Toyama JapanDepartment of Surgery and Science, Faculty of Medicine, Academic Assembly University of Toyama Toyama JapanAbstract Background There have been few studies of countermeasures against postoperative cholangitis, a serious complication after pancreaticoduodenectomy (PD) that impairs quality of life. Objective To evaluate our recently developed, novel method of choledochojejunostomy with a larger anastomotic diameter, the “T‐shaped anastomosis.” Methods The study included 261 cases of PD. The T‐shaped choledochojejunostomy technique was performed with an additional incision for a distance greater than half the diameter of the bile duct at the anterior wall of the bile duct and the anterior wall of the elevated jejunum. To compensate for potential confounding biases between the standard anastomosis group (n = 206) and the T‐shaped anastomosis group (n = 55), we performed propensity score matching (PSM). The primary endpoint was the incidence of medium‐term postoperative cholangitis adjusted for PSM. Results In the PSM analysis, 54 patients in each group were matched, and the median bile duct diameter measured by preoperative CT was 8.8 mm versus 9.3 mm, the rate of preoperative biliary drainage was 31% versus 37%, the incidence of cholangitis within 1 month before surgery was 9% versus 13%, and the incidence of postoperative bile leakage was 2% versus 2%, with no significant differences. The incidence of medium‐term postoperative cholangitis was 15% versus 4%, and multivariate logistic regression revealed that T‐shaped choledochojejunostomy was an independent predictor of a reduced incidence of cholangitis (odds ratio, 0.17, 95% CI 0.02–0.81; p = 0.024). Conclusions The T‐shaped choledochojejunostomy technique was shown to be effective with a significant reduction in the incidence of medium‐term postoperative cholangitis. Clinical trial identification: UMIN000050990.https://doi.org/10.1002/ags3.12744cholangitischoledochojejunostomypancreatoduodenectomypostoperative complicationT‐shaped anastomosis |
| spellingShingle | Nana Kimura Takamichi Igarashi Kenta Murotani Ayaka Itoh Toru Watanabe Katsuhisa Hirano Haruyoshi Tanaka Kazuto Shibuya Isaku Yoshioka Tsutomu Fujii Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis Annals of Gastroenterological Surgery cholangitis choledochojejunostomy pancreatoduodenectomy postoperative complication T‐shaped anastomosis |
| title | Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis |
| title_full | Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis |
| title_fullStr | Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis |
| title_full_unstemmed | Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis |
| title_short | Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis |
| title_sort | novel choledochojejunostomy technique t shaped anastomosis for preventing the development of postoperative cholangitis in pancreatoduodenectomy a propensity score matching analysis |
| topic | cholangitis choledochojejunostomy pancreatoduodenectomy postoperative complication T‐shaped anastomosis |
| url | https://doi.org/10.1002/ags3.12744 |
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