Wang H, Fu YX, Song WL, Mo CB, Feng G, Zhao J, Pei GH, Shi XF, Wang Z, Cao Y, Nian YQ, Shen ZY. Suture ligation for submucosal hemostasis during hand-sewn side-to-side duodeno-ileostomy in simultaneous pancreas and kidney transplantation. World J Gastrointest Surg 2021; 13(9): 988-999 [PMID: 34621475 DOI: 10.4240/wjgs.v13.i9.988]
Corresponding Author of This Article
Ying-Xin Fu, MD, Chief Doctor, Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. yingxinfu@nankai.edu.cn
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hui Wang, Ying-Xin Fu, Wen-Li Song, Chun-Bai Mo, Gang Feng, Jie Zhao, Guang-Hui Pei, Xiao-Feng Shi, Zhen Wang, Yu Cao, Ye-Qi Nian, Zhong-Yang Shen, Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
Author contributions: Wang H contributed to acquisition of data and wrote the manuscript; Fu YX and Shen ZY provided substantial contribution to the conception and design of the study and corrected the manuscript; Song WL, Mo CB, Feng G, Zhao J, Pei GH, Shi XF and Wang Z performed operations and provided study materials of the patients; Cao Y and Nian YQ contributed to acquisition of data, analysis, and interpretation of data.
Supported byNational Natural Science Foundation of China, No. 81970654.
Institutional review board statement: The study was approved by the clinical research ethics committee of the Tianjin First Central Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The anonymous dataset is available on request from the corresponding author at yingxinfu@nankai.edu.cn.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Xin Fu, MD, Chief Doctor, Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. yingxinfu@nankai.edu.cn
Received: March 22, 2021 Peer-review started: March 22, 2021 First decision: May 13, 2021 Revised: May 17, 2021 Accepted: August 10, 2021 Article in press: August 10, 2021 Published online: September 27, 2021 Processing time: 180 Days and 6.5 Hours
Abstract
BACKGROUND
Enteric anastomotic (EA) bleeding is a potentially life-threatening surgical complication associated with enteric anastomosis during simultaneous pancreas and kidney transplantation (SPKT).
AIM
To investigate whether suture ligation (SL) for submucosal hemostasis during hand-sewn enteric anastomosis could decrease the morbidity of early EA bleeding in SPKT.
METHODS
We compared the outcomes of 134 patients classified into SL (n = 44) and no SL (NSL) groups (n = 90). This study adheres to the declarations of Istanbul and Helsinki and all donors were neither paid nor coerced.
RESULTS
During the first postoperative week, the EA bleeding rate in the SL group was lower than that in the NSL group (2.27% vs 15.56%; P = 0.021); no relationship was found between EA bleeding and donor age, mean pancreatic cold ischemia time, platelet count, prothrombin time international normalized rate, activated partial thromboplastin time, and thrombin time. Anastomotic leakage was observed in one case in the SL group at postoperative day (POD) 14 and in one case at POD 16 in the NSL group (P = 0.754). No significant difference was found between the two groups in the patient survival, pancreas graft survival, or kidney graft survival.
CONCLUSION
SL for submucosal hemostasis during hand-sewn enteric anastomosis in SPKT can decrease the morbidity of early EA bleeding without increasing the anastomotic leakage rate.
Core Tip: Enteric anastomotic (EA) bleeding is a potentially life-threatening complication of simultaneous pancreas and kidney transplantation (SPKT) and can result in graft loss; therefore, it is essential to lower the incidence of EA bleeding. This study aimed to investigate whether suture ligation for submucosal hemostasis during enteric anastomosis could decrease the morbidity of early EA bleeding in SPKT. By comparing the outcomes of patients of suture ligation and no suture ligation groups, we found that suture ligation for submucosal hemostasis during enteric anastomosis in SPKT can decrease the morbidity of early EA bleeding without concurrently increasing the anastomotic leakage rate.
