0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

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

Timothy R. Donahue, MD1,2
[+] 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.
Text Size: A A A
Published online

Extract

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.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();