Common Bile Duct Transection

[zeloc]

Can someone explain what a loop choledochojejunostomy is vs. roux-en-y choledochojejunostomy and which is preferable in a complete transection of the CBD? I cannot find any good pictures on the Internet nor is it in Lawrence the Essentials. Thanks in advance.

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[Pilot Doc]

Can someone explain what a loop choledochojejunostomy is vs. roux-en-y choledochojejunostomy and which is preferable in a complete transection of the CBD? I cannot find any good pictures on the Internet nor is it in Lawrence the Essentials. Thanks in advance.

In a loop choledocho-j, you take a piece of intact intestine and anastamose it to the CBD stump. In this case, your native intestinal continuity is unchanged. In the Roux-y, the bowel is transected and the distal end is anastamosed to the CBD stump. The proximal end is then anastamosed 30-60 cm downstream of the distal stump to CBD anastamosis. I think, but can't swear, that the advantage here is less chance of cholangitis from intestinal contents refluxing into the biliary tree. Do a lit search for papers by S M Strasberg. He has written a lot on management of CBD injuries.