Choledochoduodenostomy in calculous biliary tract disease

Abstract

During a 14-year period ending in June 1979, 342 patients with calculous biliary disease underwent choledochoduodenostomy either as a primary procedure or during reoperation. Eighty per cent of the patients were aged 50 years or more. Follow-up was either by personal interview and physical examination or by means of a questionnaire, 90 per cent of the patients being assessed at periods ranging from 6 months to 14 years. A high incidence of common bile duct dilatation was found in older patients, in patients with a long history and in patients submitted to reoperation. There were no operative deaths. Postoperative complications occurred in 22 cases (6.4 per cent) and, in particular, no patient developed ascending cholangitis or symptoms related to the "blind segment". Choledochoduodenostomy is a valuable and safe procedure and can be used on wide indications, especially where peroperative cholangiography is not available.

Robotic choledochojejunostomy with intracorporeal Roux limb construction

“…Initial resistance to such procedures were based on the presumption of an increase in alkaline gastric reflux and an increase risk of the so-called 'sump syndrome', where vegetable matter is thought to obstruct the anastomosis, predisposing to cholangitis (1,2). However, subsequent reports showed that sump syndrome does not occur (3) or, if it does, occurs only extremely infrequently (4,5) and is actually due to an inadequatesized anastomosis. An additional benefit of the side-to-side anastomosis is that postoperative endoscopic access to the biliary tree is still possible if required.…”

Operative Results of Side-To-Side Choledochoduodenostomy for Cholelithiasis

“…Lygidakis [6] observed the occurrence of postopera tive complications, including incisional hernia, suture problems (stitch abscess or retained unabsorbable suture causing discomfort) and intercostal neuralgic pain in 6.4% of his patients, and reported that no patient devel oped ascending cholangitis or symptoms related to the blind segment. Furukawa et al [9] reported the develop ment of clinical symptoms including pain, fever and jaundice in 33% of their patients.…”

“…Especially, in many hospitals of Europe and North America, this procedure is carried out as an adjunct to choledocholithotomy, and excellent results have been reported [6,8]. On the other hand, in Japan this operation has also been performed when sim ilar operative procedures were indicated [5,9], But, many people have been critical of this procedure because a blind pouch in the lower region of the choledochus is formed by this operation, and there is a possibility for the occurrence of ascending cholangitis, the sump syn drome, recurrent bile duct stones and pancreatitis [1,3,4], In fact, many investigators, including the authors, have experienced such complications caused by side-toside choledochoduodenostomy.…”

“…Lygidakis [6] observed 14 deaths during follow-up and reported cancer, cardiac insufficiency, urinary tract infection and car accidents as its causes. In contrast, of our patients who died 46% suffered from cholangitis, and half of them had intrahepatic stones.…”

“…However, this adjunctive procedure has ana tomic faults such as the possible accompanying problem of a distal blind pouch and double flows of bile, and there is also the possibility of occurrence of the sump syndrome or ascending cholangitis [1][2][3][4]. Therefore, in most Japanese hospitals this procedure is carried out only as an adjunct to surgery on poor risk patients with choledocholithiasis, or as a by-pass operation in the treatment of patients who had unresectable tumors in the region of the pancreas head [5], In Europe and North America, this adjunctive procedure is still performed at present for the management of choledocholithiasis and associated diseases [3,[6][7][8], In addition, there are many reports revealing good results in the follow-up studies. Therefore, we are interested in the actual long-term results after this procedure.…”