Study Examines Biliary Reconstruction Method

Duodenal anastomosis (a surgical procedure involving creating a connection with the duodenum, the first section of the small intestine) appears to be a safe and simple method for biliary reconstruction (reconstruction of the bile duct system) that can be successfully performed with low rates of leak, stricture (narrowing), cholangitis (infection of the bile duct), and bile gastritis, according to a study by J. Bart Rose, M.D., M.A.S., of Virginia Mason Medical Center, Seattle, Washington, and colleagues.

A retrospective record review of 96 nonpalliative biliary reconstructions performed between February 2000 and November 2011 for bile-duct injury, cholangiocarcinoma (cancerous tumors of the bile duct), choledochal cysts (rare congenital swelling of the hepatic or bile duct of a child’s liver), or benign strictures was conducted. The procedures included 59 duodenal reconstructions and 37 Roux-en-Y jejunal reconstructions.

According to the study results, anastomosis-related complications (leaks, cholangitis, or strictures) were fewer in the duodenal than the jejunal group (7 patients versus 13 patients).

“Our experience suggests that in most situations, use of the duodenum for biliary reconstruction has low morbidity, stricture rates, and risk for cholangitis or bile gastritis, while being more endoscopically accessible than the jejunum,” the authors conclude.

(JAMA Surgery. Published online July 24, 2013. doi:10.1001/jamasurg.2013.2701.