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Background:
Surgical reconstruction of the biliary system is required for a variety of reasons. Roux-en-Y jejunal anastomoses (RJA) are the current gold standard for repair. Direct duodenal anastomoses (DDA) are a less common approach, however it has the benefit of operative simplicity and ease of endoscopic evaluation. We compared the outcomes of non-palliative DDA to RJA.

Methods:
A retrospective cohort study was performed at a single tertiary care center comparing DDA to RJA between the years 2000 and 2010. Standard patient demographics, complications rates, mortality rates, need for endoscopic or radiologic interventions, and long term outcomes were compared.

Results:
A total of 105 non palliative reconstructions were performed between 2000 and 2010. 67 DDA and 38 RJA reconstructions were performed in an end-to-side fashion for either bile duct injury, cholangiocarcinoma, choledochal cysts, or benign strictures. The groups were similar with regard to demographics, preoperative diagnoses, postoperative length of stay (7 days vs. 7.5 days), postoperative mortality rates (1.7% vs. 2.9%; P=0.72), and overall (Grade III or greater) complication rates (47.1% vs. 47.1%; P=0.83). However, anastomotic related complications (leaks, abscesses/bilomas, or strictures) were fewer in the DDA cohort (11.7% vs. 35.3%; P=0.01). Of those developing stricture, 5 of 6 in RJA cohort required percutaneous transhepatic access for management, as opposed to only 1 of 3 in the DDA cohort.

Conclusion:
Direct duodenal anastomosis is a safe and often preferable method for biliary reconstruction. It may have decreased anastomotic complication rates, while benefiting from easier postoperative endoscopic management.