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Common Bile Duct Transection

Discussion in 'Surgery and Surgical Subspecialties' started by zeloc, Apr 7, 2007.

  1. zeloc

    zeloc Senior Member
    Physician Faculty 10+ Year Member

    Aug 22, 2003
    Likes Received:
    Attending Physician
    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.
  2. Pilot Doc

    Pilot Doc SDN Angel
    Moderator Emeritus 15+ Year Member

    Mar 6, 2002
    Likes Received:
    Resident [Any Field]
    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.

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