Suture ligation for submucosal hemostasis during hand-sewn sideto-side duodeno-ileostomy in simultaneous pancreas and kidney transplantation

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.