Discussion
cholangitis, jaundice, cholestasis, CSG, anastomotic leakage, fragile bile ducts where biliary stenosis, stenosis
LIVER ABSCESSES, CHOLANGITIS, POSTOPERATIVE COMPLICATIONS, DISEASE, COMPLICATION, SECONDARY, CHOLESTASIS, LEAKAGE, STENOSIS, COMPLICATIONS
In this prospective, randomized clinical study, a significantly shorter suture time for the continuous compared with the IS technique was found; however, no significant difference in short-term postoperative complications between both groups was observed. Bile leakage, the most common short-term biliary complication after BEA that can necessitate interventional or surgical treatment, occurred in six (14.6 per cent) patients of the CSG and four (10.3 per cent) patients in the ISG. Furthermore, only one patient in the CSG (2.4 per cent) and no patient in the ISG developed a cholangitis as a short-term complication. Three patients in the CSG developed liver abscesses, but none in the ISG. Looking at the long-term complications, including jaundice, cholestasis, and BEA stenosis, there was no difference between the two groups. During follow-up, 19 (46.3 per cent) patients in the CSG and 19 (48.7 per cent) in the ISG died due to their oncological disease; the shorter survival is a possible confounder masking differences in such long-term complications. Furthermore, the distance of the BEA to the biliary confluence was not associated with short-term or long-term complications in both groups. A possible reason might be that only the CHD and not the CBD was used for the BEA. The blood supply of the BEA was always good and a risk factor for stenosis was eliminated. Therefore, the length of the remaining hepatic duct has not been confirmed as a risk factor for anastomotic leakage in this study.These findings are in line with a retrospective study that compared continuous and IS techniques for choledochocholedochostomy during liver transplantation in 100 patients and reported an incidence of biliary complications of 16.1 per cent for the CSG and 13.2 per cent for the ISG, with no significant difference between the two groupsA limitation of the present study is that only common hepatic ducts with a diameter of at least 7 mm were included. Furthermore, the limited patient number limits the power of secondary outcomes. Further studies, including small and fragile bile ducts where biliary stenosis is more common are needed to determine the complication rates of CS 