Retrospective comparative study between conventional duct-to-mucosa versus mucosal fixation hepaticojejunostomy in biliary diversion procedures

Background
The different techniques of hepaticojejunostomy (HJ) are understudied. The aim of the study was to compare the surgical outcomes of conventional duct-to-mucosa HJ and mucosal fixation HJ. HJ is regarded as the definitive management of iatrogenic bile duct injuries, as well as the manner for restoring biliary enteric continuity after resection of benign or malignant tumors.
Patients and methods
Records of patients treated by HJ at the Department of Surgery, Medical Research Institute, Alexandria University and Gastroenterology Surgery Unit, Alexandria Main University Hospital were divided into two groups: those who underwent conventional duct-to-mucosa HJ (G1) and mucosal fixation HJ (G2). The primary outcome measure was the rate of bile leakage; secondary outcomes included operative time, day to resume oral feeding, postoperative morbidity, and mortality.
Results
A total of 143 patients treated by HJ were divided into two groups. The mean duration of hepaticojejunosotmy anastomosis was 29.88±6.72 in G2 versus 32.45±7.43 in G1. The overall morbidity in the mucosal fixation HJ group was significantly lower than in the conventional HJ group [23/52 (44.2%) vs. 56/91, 61.5%, =0.045]. Biliary leakage incidence was higher in group 1 (21, 23.1%) than in group 2 (5, 9.6%, =0.045) with reexploration required in two patients. The duration of hospital stay and time to start oral feeding were longer in G1 compared with G2.
Conclusion
The mucosal fixation HJ is a reliable and an efficient technique of biliary diversion as part of pancreaticoduodenectomy or common bile ductinjury or stricture repair. Mucosal fixation HJ leads to a lower incidence of biliary leakage and overall complications (regardless of the grade) due to better sealing of anastomosis and healthier blood supply. The incidence of biliary leakage was associated with postoperative pancreatic fistula in pancreaticoduodenectomy surgeries, yet no other significant associations could be identified. Mortality was not statistically different between the conventional HJ group and the mucosal fixation HJ group.