Duodenal Anastomosis Preferable for Biliary Reconstruction

A new study concludes that duodenal anastomosis is a safe, simple, and often the preferable method for biliary reconstruction.

Researchers at Virginia Mason Medical Center (Seattle, WA, USA) conducted a retrospective record review of 96 patients that underwent nonpalliative biliary reconstructions between February 1, 2000, and November 23, 2011. The biliary reconstruction was performed via end-to-side Roux-en-Y jejunal anastomosis (39 patients) or direct duodenal anastomosis (59 patients). The primary end points were anastomosis-related complications (leak, cholangitis, bile gastritis, or stricture), and the secondary end points were overall complications, endoscopic or radiologic interventions, readmissions, and death.

The results for both surgical procedures were similar with regard to demographics, operative indications, postoperative length of stay, and mortality rates. However, anastomosis-related complications were fewer in the duodenal than the jejunal cohort, affecting 7 patients (12%) as compared to 13 (35%). Of patients with stricture, 5 of 9 in the jejunal cohort required percutaneous transhepatic access for management, compared with only 1 of 2 in the duodenal cohort. The study was published online on August 2, 2013, in JAMA Surgery.

“Duodenal anastomosis can successfully be performed to all levels of the biliary tree with low rates of leak, stricture, cholangitis, and bile gastritis,” concluded lead author John Bart Rose, MD, and colleagues of the department of general and thoracic surgery. “When anastomotic complications do occur, there is less need for transhepatic intervention because of easier endoscopic access.”

Bile duct reconstruction becomes necessary if the biliary system is accidentally injured during hepatic laparoscopic procedures, occurring in about 0.1% of all cholecystectomies. In addition, biliary complications can occur during and after liver, gastric, duodenal, and pancreas surgery, as well as following liver transplantation. Complications can occur early after a surgery or much later, and often require extensive surgical repair.

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