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June 1996

Invited Commentary

Author Affiliations

Virginia Mason Clinic, Seattle, Wash

Arch Surg. 1996;131(6):640. doi:10.1001/archsurg.1996.01430180066013

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The hypothesis of this study is that the frequency of stricture after a biliary-enteric anastomosis would be lessened if a single-layer technique were used without T-tube drainage. The variables to consider when reading this study are many—single layer of sutures, interrupted suture, knots tied on the outside, seromuscular suture placement without exposure to bile flow, rapidly absorbable suture, use of jaundiced animals, and the absence of a T tube.

One of the most common causes of stricture after a biliary-enteric anastomosis and/or bile duct injury is compromised blood supply to the bile duct portion of the bilioenteric anastomosis. A logical assumption is that interrupted rather than continuous sutures will be less likely to interfere with the blood supply. In addition, the authors' technique minimizes chronic inflammation and scar formation because it is a single-layer technique and uses absorbable suture not exposed to the mucosa. Tying the knots on the outside

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