Choledochoduodenostomy Analysis of 71 Cases Followed for 5 to 15 Years

Abstract

To investigate the long-term effectiveness of choledochoduodenostomy (CDD), the experience with 71 patients followed for 5 or more years after CDD was analyzed retrospectively. From 1968 to 1984, 134 patients underwent CDD. Eight patients (6%) died in the immediate postoperative period, 55 left the hospital, 8 of them were lost to follow-up, and 47 were followed but died before 5 years elapsed after CDD. The remaining 71 patients form the data base for this analysis: 38 were followed for more than 5 years, 25 were followed for more than 10 years, and 8 were followed for more than 15 years (mean 12.1 years +/- 1.3 SEM). Choledocholithiasis, chronic pancreatitis, and postoperative stricture were the indications for CDD. Cholangitis was observed in only three patients. The diameter of the common bile duct (CBD) was large in most patients (mean 18 mm +/- 0.9 SEM). These results infer that CDD is effective to treat non-neoplastic obstructing lesions of the distal CBD on a long-term basis and that the presence of a dilated CBD (more than 16 mm) that allows the construction of a CDD more than 14 mm is essential to obtain good results.

An audit of the outcome of long-term biliary stenting in the treatment of common bile duct stones in a general hospital

“…12,13,16 Surgical procedures such as bile duct exploration and sphincteroplasty, and drainage procedures such as choledochoduodenostomy and hepaticojejunostomy, are options after failed endoscopic therapy in surgically fit patients. 41,42 In patients with previous cholecystectomy as well as in elderly patients or those with high surgical risk, endoscopic sphincterotomy and endoscopic clearance of common bile duct stones, if successful, become the definitive treatment. 43 Biliary endoprostheses have been used for biliary drainage both as a temporary measure as well as for long-term, permanent treatment.…”

Management of Common Bile Duct Stones

“…This complication is rare (w1%), and can be managed with ERC/ES. 47,48 Other authors have suggested end-to-side choledochoduodenostomy as well as choledochojejunostomy as alternatives, 49 although endoscopic biliary access following these operations is nearly impossible. It should be acknowledged that laparoscopic choledochoenterostomies have also been reported anecdotally, 50 although there has been little experience with this technique.…”

Choledochoduodenostomy in the Present Era: Specific Indications and Outcomes

“…Most of these authors stipulate that the diameter of the CBD should be at least 16 mm for good outcomes of CDD. 4,6,7 There are specific indications for performing CDD, most of which have remained unchanged over time. It has been recommended in the treatment of multiple CBD stones, retained or residual stones following a prior biliary intervention, primary CBD stones, lower-end CBD strictures, dilated CBD with a diameter of more than 2 cm, or failure of ERCP.…”