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and the bile is aspirated. The incision is enlarged and an incision 0.5 cm smaller is made in the antimesenteric border of the duodenum. An elliptical piece of duodenal mucosa 2-3 mm wide is excised on the border of the duodenal incision, and the mucosal surface of the gall bladder is sutured to the mucosal surface of the duodenum in a simple continuous pattern. Sutures penetrate the submucosa and serosa of both organs to ensure adequate suture holding power. The near side serosal layer is then approximated and omentum is draped around the anastomosis after its patency and integrity are checked by injecting saline into the duodenal lumen. Postoperative antibiotics are indicated and complications after surgery include hemorrhage, biliary-enteric anastomotic dehiscence or breakdown, gall bladder injury (necrosis), and pancreatitis. Ascending septic cholecystitis and hepatitis may occur if the stoma diameter is inadequate. Bile Duct Lacerations Lacerations of the bile duct are difficult to diagnose. If bile peritonitis is diagnosed, exploration of the extrahepatic bile ducts is required. In some situation the damage to the bilary duct or ducts is not repairable, and a cholecystoduodenostomy is performed following double ligation of the bile duct on each side of the laceration. A direct end-to-end anastomosis of the bile duct may be attempted if the diameter is greater than 5 mm. Suture material size 4-0 or 5-0 synthetic absorbable suture. Postoperative stricture is common. Tube stents may be used prior to suturing to provide bile drainage during healing, minimize bile leakage and they can prevent stricture formation if left in long enough (up to 6 weeks). References: 1. Slatter, DH, ed. Textbook of Small Animal Surgery. Philadelphia:WB Saunders Co, 1985: p 794-827, p 1156-1174, p 1204-1218. 2. Bojrab, J, ed. Current Techniques in Small Animal Surgery. Philadelphia:JB Lippincott Co, 1990: p 291-308, p 544-548.