Intraoperative Dilatation and Air-Tight Testing of the Hepaticojejunostomy: A New Technique.

OBJECTIVE: To evaluate the effect of creating an air-tight anastomosis and intraoperative dilatation of the hepaticojejunostomy (HJ) in reducing the early and long-term complications.

STUDY DESIGN: Interventional study.

PLACE AND DURATION OF STUDY: Department of Surgery, King Saud University, Riyadh, between March 2008 and January 2016.

METHODOLOGY: After completion of HJ, the anastomosis was tested for air-tightness, and dilated with Kelly clamp in all patients undergoing the procedure. The anastomosis was reinforced with extra suture in cases of air leak. Comparison was performed between the patients who underwent HJ by the same surgeon, after and before the new technique.

RESULTS: Sixty-seven patients underwent HJ during the study period. Air leaks from HJ were observed in 3 patients before anastomotic dilatation. The anastomosis was reinforced in these patients. No air leak was observed after dilatation of the anastomosis. There was no postoperative bile leak in any patient. However, during the follow-up 3 patients presented with recurrent cholangitis and stricture formation at the HJ site required surgical revision. The new technique had significantly reduced the rate of bile leak (p=0.029) and stricture (p=0.037) at the site of HJ when compared with patients who underwent HJ without the new technique.

CONCLUSION: Creation of air-tight HJ anastomosis has completely eliminated the postoperative bile leak and reduced the rate of HJ stricture formation. The addition technique resulted in insignificant prolongation of operative time. There was no technique related complication.