Evidence map›Paper›PMID 40613910›Full record

SynthesisLangenbeck's archives of surgery2025

Continuous vs. interrupted suturing in hepaticojejunostomy: a comprehensive systematic review and meta-analysis.

Ahmed Abdelsamad, Mohammed Khaled Mohammed, Ibrahim Khalil, Zeyad M Wesh, Omar A Ahmed, Ahmed Elsherif, Jawad J F Alqedra, Khaled Ashraf Mohamed, Eslam Elmaghraby, Torsten Herzog and 1 more

Abstract readSystematic ReviewMeta-AnalysisComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Langenbeck's archives of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Ahmed AbdelsamadSurgery Department II, University of Witten/Herdecke, 58455, Witten, Germany. Ahmed6361410@gmail.com.
Mohammed Khaled MohammedFaculty of Medicine, Cairo University, Cairo, Egypt.
Ibrahim KhalilFaculty of Medicine, Alexandria University, Alexandria, Egypt.
Zeyad M WeshFaculty of Medicine, Alexandria University, Alexandria, Egypt.
Omar A AhmedFaculty of Medicine, Ain Shams University, Cairo, Egypt.
Ahmed ElsherifSt. Josef Hospital Bochum, Bochum, Germany.
Jawad J F AlqedraFaculty of Medicine, Cairo University, Cairo, Egypt.
Khaled Ashraf MohamedGeneral Surgery Department, Cairo University, Giza, Egypt.
Eslam ElmaghrabyDepartment of Surgery (A), Heinrich-Heine University Hospital Düsseldorf -UKD, 40225, Düsseldorf, Germany.
Torsten HerzogSurgery Department, Ruhr University Bochum, Bochum, Germany.
Florian GebauerSurgery Department II, University of Witten/Herdecke, 58455, Witten, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHepaticojejunostomy (HJ) is a crucial reconstructive step in upper gastrointestinal (UGI), pancreaticoduodenectomy (PD), and Hepaticobiliarypancreatic (HBP) surgeries. The optimal suturing technique remains debated, with conflicting evidence regarding operative efficiency, costs, and complications. This meta-analysis compares continuous and interrupted suturing to provide evidence-based recommendations.

methodsA systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane Library. Primary outcomes were anastomotic time and costs, while secondary outcomes included bile leakage, anastomotic stricture, morbidity, cholangitis, hospital stay, and re-exploration rates. A random or fixed-effects model was applied based on heterogeneity. We included randomized controlled trials and non-randomized cohort studies. The risk of bias was assessed using the Cochrane ROB 2 tool, Newcastle-Ottawa Scale (NOS), and MINORS instrument as appropriate. Additionally, the quality of evidence for each outcome was evaluated using the GRADE approach. Sensitivity analyses were performed using the leave-one-out method.

resultsSeven studies (1,159 patients) were included (continuous: 388, interrupted: 771). Continuous suturing significantly reduced anastomotic time (MD = -13.06 min, 95% CI: -17.37 to -8.75, P < 0.001) and costs (SMD = -4.89, 95% CI: -6.10 to -3.67, P < 0.001). However, no significant differences were observed in bile leakage, anastomotic stricture, morbidity, cholangitis, hospital stay, or re-exploration rates (P > 0.05). Sensitivity analyses confirmed these findings.

conclusionContinuous suturing reduces anastomotic time by ~ 13 min and costs by ~ $90 without increasing complications. While these differences may be statistically significant, their clinical relevance can vary depending on the surgical context. Surgical choice should consider surgeon expertise, institutional protocols, and patient factors. Further randomized controlled trials are necessary to validate these findings.

Indexed as

JejunostomySuture TechniquesAnastomosis, SurgicalHumansOperative TimePostoperative ComplicationsContinuous suturesHepaticojejunostomyInterrupted suturesMeta-analysisSurgical outcomes

Identifiers

PMID40613910
PMCPMC12227507

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.