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Study by Virginia Mason Physicians Examines Biliary Reconstruction Method
SEATTLE – (July 26, 2013) — Duodenal anastomosis (a surgical procedure creating a connection with the duodenum, the first section of the small intestine) appears to be a safe and simple method for reconstruction of the bile duct system that can be successfully performed with low rates of leak, narrowing, infection of the bile duct and bile gastritis, according to a study involving several Virginia Mason physicians.
Their article about the study has been published online by JAMA Surgery. Read the abstract.
A retrospective record review was conducted on 96 non-palliative 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. The procedures included 59 duodenal reconstructions and 37 Roux-en-Y jejunal reconstructions. The study found anastomosis-related complications (leaks, cholangitis or strictures) were fewer in the duodenal than the jejunal group (seven 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. “When anastomotic complications do occur, there is less need for transhepatic intervention because of easier endoscopic access.”
Current Virginia Mason physicians participating in the study were J. Bart Rose, MD, MAS; Thomas Biehl, MD, FACS; Phillip Bilderback, MD; Scott Helton, MD; and John Ryan Jr., MD. Also involved while at Virginia Mason were Tal Raphaeli, MD, and William Traverso, MD.
In the invited commentary to their report, Timothy Donahue, MD, of the Department of Surgery at the David Geffen School of Medicine at UCLA, said they “should be commended for using ‘the organ less traveled’ for a complex problem. Although the outcomes obtained with the jejunum and duodenum would best be directly compared in a randomized trial, the authors’ results and experience suggest that one should consider using the duodenum, because ‘it’s right there.’”
About Virginia Mason Medical Center
Virginia Mason Medical Center, founded in 1920, is a nonprofit regional health care system in Seattle that serves the Pacific Northwest. Virginia Mason employs more than 5,300 people and includes a 336-bed acute-care hospital; a primary and specialty care group practice of more than 460 physicians; satellite locations throughout the Puget Sound area; and Bailey-Boushay House, the first skilled-nursing and outpatient chronic care management program in the U.S. designed and built specifically to meet the needs of people with HIV/AIDS. Benaroya Research Institute at Virginia Mason is internationally recognized for its breakthrough autoimmune disease research. Virginia Mason was the first health system to apply lean manufacturing principles to health care delivery to eliminate waste and improve quality and patient safety.
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