Effects Of Suture Type And Anastomosis Method On Biliary Anastomotic Stricture After Liver Transplantation

Objective:1)To investigate the effects of polygluconate suture and polypropylene suture on biliary anastomotic stricture after liver transplantation,and the difference in clinical treatment difficulty when anastomotic stricture occurs2)To investigate the effects of complete discontinuous anastomosis between the anterior and posterior walls of the biliary tract,complete anterior and posterior wall anastomosis,and continuous anterior wall discontinuous anastomosis in the posterior wall on biliary anastomotic stricture after liver transplantation Methods:This study retrospectively analyzed the clinical data of 428 patients who underwent allogeneic liver transplantation in the First Hospital of Jilin University from September 2014 to August 2021,including: age,gender,Meld score,Child grade,albumin,total bilirubin,INR,creatinine,cold ischemia time,operation time,intraoperative blood loss,suture type,bile duct anastomosis,postoperative biliary anastomotic stricture and treatment.The 428 patients were divided into 4 groups according to the type of suture and the anastomosis method.Among them,142 patients underwent continuous posterior anterior wall discontinuous anastomosis with polygluconate sutures;169 patients underwent continuous posterior anterior wall discontinuous anastomosis with polypropylene sutures.44 patients underwent complete and continuous anastomosis with polypropylene sutures;73 patients underwent complete discontinuous anastomosis with polypropylene sutures.Data were analyzed using SPSS version 19.0.Measurement data were first tested for KS normality.Measurement data with normal distribution were expressed as x±s.Comparison between groups was performed using t test and analysis of variance;measurement data with skewed distribution was expressed as M（interquartile range）.Comparisons were made using the Mann-Whitney U test.Enumeration data were presented as examples,and the χ2 test was used between groups.Logistic regression analysis was used for multivariate analysis,and p < 0.05 was considered statistically significant.Results:1)Relationship between suture type and anastomotic biliary strictureWe showed that suture type was not a relevant factor influencing the incidence of anastomotic biliary stricture（p >0.05）.The differences in the time of anastomotic stricture detection（p >0.05）between the polygluconate and the polypropylene suture groups were not statistically significant.However,the difference in the time of stricture detection was statistically different when compared to the efficacy of ERCP（p <0.05）.In patients with postoperative biliary anastomotic stricture,patients with polypropylene suture anastomosis had a higher success rate with only one ERCP treatment..2)Relationship between anastomotic technique and anastomotic biliary strictureThe results showed that complete discontinuous anastomosis of the anterior and posterior walls was an independent protective factor for the incidence of post-operative anastomotic biliary strictures（OR = 0.263,95% CI: 0.075–0.914,p =0.036）.Conclusion:Using either polypropylene or polygluconate sutures to anastomose the bile ducts showed no tentative difference in the incidence of post-transplant anastomotic strictures.However,polypropylene sutures reduced the severity of post-operative strictures and treatment difficulty.In addition,complete discontinuous anastomosis of the anterior and posterior walls reduced the risk of developing post-operative anastomotic strictures.