Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2021; 13(9): 988-999
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.988
Suture ligation for submucosal hemostasis during hand-sewn side-to-side duodeno-ileostomy in simultaneous pancreas and kidney transplantation
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
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 by National 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
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.

Keywords: Anastomosis, Gastrointestinal bleeding, Hemostasis, Ligation, Pancreas, Transplantation

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.