Strengths and limitations of the study
vascular injury, intrahepatic stones, trans-anastomotic external jejunal stents, biliary stricture, liver cell failure
ABDOMINAL SEPSIS, BILIARY CIRRHOSIS, COMPLICATIONS
Our study has several strengths. To the best of our knowledge, this is one of the early RCTs evaluating the impact of reconstruction time and abdominal sepsis control on reconstruction success. It exclusively considers HJ reconstruction and excludes other reconstruction methods, creating a homogenous study. We investigated many short-term and long-term complications. Finally, our collected data from our collaborating centres had the exact homogeneous timing and endpoint. These circumstances make our study unique and raise the likelihood that conclusions will be valid. On the contrary, our study has a few limitations that should also be acknowledged. The first was the relatively short duration of the follow-up. Therefore, the outcomes examined were those that occur in the follow-up period and long-term complications such as biliary stricture, intrahepatic stones, biliary cirrhosis, and liver cell failure need a long follow-up period (up to 10 years) to be assessed. Secondly, there was no adjustment for possible confounders such as vascular injury. Thirdly, the low incidences of some complications may compromise the statistical results. Fourthly, there is no standardized procedure for reporting the outcomes for better comparison with other studies. Finally, The use of trans-anastomotic external jejunal stents and PTD based on surgeon preference and diameter of intrahepatic duct is a potential bias.