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Risk factors for anastomotic stricture after hepaticojejunostomy for bile duct injury-A systematic review and meta-analysis.
- Source :
-
Surgery [Surgery] 2021 Nov; Vol. 170 (5), pp. 1310-1316. Date of Electronic Publication: 2021 Jun 17. - Publication Year :
- 2021
-
Abstract
- Background: After major bile duct injury, hepaticojejunostomy can result in good long-term patency, but anastomotic stricture is a common cause of long-term morbidity. There is a need to assimilate high-level evidence to establish risk factors for development of anastomotic stricture after hepaticojejunostomy for bile duct injury.<br />Methods: A systematic review of studies reporting the rate of anastomotic stricture after hepaticojejunostomy for bile duct injury was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses of proposed risk factors were then performed.<br />Results: Meta-analysis included 5 factors (n = 2,155 patients, 17 studies). Concomitant vascular injury (odds ratio 4.96; 95% confidence interval 1.92-12.86; P = .001), postrepair bile leak (odds ratio: 8.03; 95% confidence interval 2.04-31.71; P = .003), and repair by nonspecialist surgeon (odds ratio 11.29; 95% confidence interval 5.21-24.47; P < .0001) increased the rate of anastomotic stricture of hepaticojejunostomy after bile duct injury. Level of injury according to the Strasberg Grade did not significantly affect the rate of anastomotic stricture (odds ratio: 0.97; 95% confidence interval 0.45-2.10; P = .93). Owing to heterogeneity of reporting, it was not possible to perform a meta-analysis for the impact of timing of repair on anastomotic stricture rate.<br />Conclusion: The only modifiable risk factor, repair by a nonspecialist surgeon, demonstrates the importance of broad awareness of these data. Knowledge of these risk factors may permit risk stratification of follow-up, better informed consent, and understanding of prognosis.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Subjects :
- Anastomosis, Surgical adverse effects
Bile Ducts injuries
Constriction, Pathologic epidemiology
Constriction, Pathologic etiology
Global Health
Humans
Incidence
Postoperative Complications etiology
Risk Factors
Bile Duct Diseases surgery
Bile Ducts surgery
Biliary Tract Surgical Procedures adverse effects
Jejunostomy adverse effects
Postoperative Complications epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-7361
- Volume :
- 170
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 34148708
- Full Text :
- https://doi.org/10.1016/j.surg.2021.05.015