Use the Duodenum, It’s Right There

Rose, J. Bart; Bilderback, Phillip; Raphaeli, Tal; Traverso, William; Helton, Scott; Ryan, John A.; Biehl, Thomas

doi:10.1001/jamasurg.2013.2701

Cited by 16 publications

(1 citation statement)

References 23 publications

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“…Secondly, data from liver transplant patients and experience from our transplant center have shown that HD gives satisfactory results [13, 14]. Others have found excellent results with HD that are comparable with HJRY in a variety of indications such as benign bile duct strictures, choledochal cysts, HPB-cancer, and bile duct injuries [15–18]. A recent report advocated HD as the preferred method of biliary reconstruction and described it is as a safe and simple technique with low rates of leak, stricture, cholangitis, and bile gastritis [17].…”

Section: Discussionmentioning

confidence: 99%

Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric Bypass

Yaqub

Mala

Mathisen

et al. 2014

Case Reports in Surgery

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Introduction. Most surgeons prefer Roux-en-Y hepaticojejunostomy (RYHJ) for biliary reconstruction following a common bile duct (CBD) injury. However, in patients with a Roux-en-Y gastric bypass (RYGB) a RYHJ may be technically challenging and can interfere with bowel physiology induced by RYGB. The use of a hepaticoduodenostomy (HD) resolves both these issues. Presentation of Case. We present a case of CBD injury during laparoscopic cholecystectomy one year after laparoscopic RYGB for morbid obesity. Due to adhesions and previous surgery with RYGB, we did not want to interfere with the RYGB physiology by anastomosing the CBD to the jejunum or ileum. Succeeding a full Kocher's maneuver we performed biliary reconstruction by a tension-free end-to-side HD. The postoperative recovery was uneventful and the patient was discharged after eight days. At four-month follow-up, the patient had stable weight and normal laboratory test results. MRCP demonstrated normal intra- and extrahepatic bile ducts with status after HD. Discussion. We propose that HD should be considered in treatment of CBD injury in post-RYGB patients as it may reduce the risk of interfering with the post-RYGB physiology.

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