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Invited Commentary
September 2013

Should the Duodenum Be “the Road Less Traveled” for Biliary Reconstruction?

Author Affiliations
  • 1Division of General Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
  • 2Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
JAMA Surg. 2013;148(9):865-866. doi:10.1001/jamasurg.2013.2710

Of all anastomoses used for biliary reconstruction, the end-to-side bile duct to duodenum and Roux-en-Y duct to jejunum have emerged as the most common. Although most surgeons use the jejunum, Rose et al1 from Virginia Mason Medical Center in Seattle prefer using the duodenum and have amassed a large experience with this procedure.

Their current study builds on an earlier series from the same institution2 that focused on patients undergoing reconstruction for bile duct injuries during cholecystectomy and concluded that the duodenum was safe to use. Although most bile duct injuries occur high on the bile duct,3 tension was not observed on the duodenal anastomoses. The major concern with using the duodenum was that leaks result in duodenal fistulas, which may be associated with greater morbidity than leaks from an isolated jejunal limb.