Long-term follow-up after choledochojejunostomy for bile duct stones with complex clearance of the bile duct

Gouma, D. J.; Konsten, J.; Soeters, Peter B.; Meyenfeldt, Maarten von; Obertop, H.

doi:10.1002/bjs.1800760509

Cited by 7 publications

(8 citation statements)

References 14 publications

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“…Before the availability of EST, CJS was performed for choledocholithiasis 66 . More than a decade ago, CJS was not commonly selected as a treatment option for choledocholithiasis because: (i) endoscopic cannot be performed when anastomotic stenosis has occurred and (2) surgical techniques are complicated 3 .…”

Section: Resultsmentioning

confidence: 99%

Risk factors and management of primary choledocholithiasis: a systematic review

Zhang

Ling

2020

ANZ Journal of Surgery

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Background Primary choledocholithiasis (PC) is a common disease in biliary surgery. The treatment is always challenging due to its high recurrence. A systemic review is undertaken to determine the risk factors for recurrence and provide with the individualized management strategy. Methods Electronic databases PubMed (Medline), Embase and Cochrane Central Register of Controlled Studies were searched for relevant articles on risk factors for PC recurrence. Its therapeutic intervention was also collected and analysed. Results A total of 36 articles were eligible for inclusion. The recurrent risk factors include abnormalities of biliary anatomy (peripapillary diverticulum), dynamics (choledochal dilation, sharp angulation and stone number), metabolism (advanced age and hypothyroidism) and bacterial infection (Enterobacter and Helicobacter pylori). These factors eventually induce cholestasis and stone formation. At present, there is no guideline and expertise consensus for PC management. The treatment mainly consists of stone retrieval approaches and internal drainage surgeries. The former are minimally invasive methods: endoscopic sphincterotomy (EST), papillary balloon dilation (EPBD) and laparoscopic common bile duct exploration (LCBDE). The latter include choledochoduodenostomy (CDS) and choledochojejunostomy (CJS) with Roux‐en‐Y reconstruction. By far, the internal drainage surgeries have significantly lower recurrence than stone retrieval approaches. Conclusion Abnormal biliary anatomy, dynamics, metabolism and bacterial infection are the risk factors for PC. Both EST/EPBD and LCBDE can be performed as initial treatment. For recurrent PC, CDS is more suitable to the elderly, while Roux‐en‐Y CJS reserves for young patients or those in good conditions.

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Section: Resultsmentioning

confidence: 99%

Risk factors and management of primary choledocholithiasis: a systematic review

Zhang

Ling

2020

ANZ Journal of Surgery

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“…1 and 2) are favored methods of biliary enteric anastomosis [1]. About 98 % good results in patients followed up for 8 years have been recommended [11]. There is reluctance on the part of many experienced surgeons to perform side-to-side choledochoduodenostomy for fear that the flow of partly digested food might cause ascending cholangitis, but long-term follow-up in patients who have undergone this type of anastomosis does not provide justification for this fear [12].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Biliary Enteric Anastomosis in Benign Biliary Disorders

Singh

Arora

2012

Indian J Surg

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Evaluation of various methods of biliary enteric anastomosis in benign biliary diseases (BBD).A surgeon operating for BBD needs to improve the internal drainage of bile to prevent stasis and its backpressure effects. This is best obtained by biliary enteric anastomosis. A total of 121 cases of biliary enteric anastomosis in BBD were included in this study. The postoperative course and long-term outcome were studied prospectively. In the choledochoduodenostomy group, there were no leaks, no restrictures, and no mortality. Five (10.41 %) patients had cholangitis attacks and 2 (4.17 %) patients had sump syndrome. The choledochojejunostomy group had no leaks, no restrictures. Two (7.14 %) patients had repeated cholangitis and 2 (7.14 %) patients had sump syndrome, no mortality. The hepaticojejunostomy group had 3 cases of anastomotic leak of which 2 healed spontaneously and 1 needed resurgery. There was restricture in 2 cases, in which resurgery was successful-one death, no cholangiocarcinoma. Biliary enteric anastomosis is a safe and effective method for the management of BBD. The method should be selected according to the disease pathology and patient characteristics.

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“…In a series from the area of open surgery for CBD stones, we showed that a choledochojejunostomy, as the final solution for complicated CBD stones, was successful in 98% even after 8 years of follow-up [15]. These procedures can now also be performed laparoscopically, as mentioned before.…”

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confidence: 85%

Management of Acute Cholangitis

Gouma

2003

Dig Dis

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Endoscopic sphincterotomy (ES) is the treatment of choice for patients with (severe) acute cholangitis. For fit patients without co-morbidity with mild cholangitis and CBD stones with a gallbladder in situ, the one-stage laparoscopic approach could be considered as an alternative in centers with sufficient experience. The results of both procedures are comparable. Open surgery is relatively safe. It has a high success rate, good/excellent long-term results, but is not very attractive for the patient and should not be used routinely nowadays. Therefore, the indication should be limited for management of severe complications after ES as perforations of the duodenum, large CBD stones and patients with Mirizzi’s syndrome or intrahepatic stones with stenosis of the bile duct. ES as primary treatment for CBD stones should be followed by laparoscopic cholecystectomy in ‘fit’ patients. In patients with malignant disease, particularly after repeated stent failure and subsequent cholangitis, bypass surgery should be considered in patients with a life expectancy of >3 months.

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Long-term follow-up after choledochojejunostomy for bile duct stones with complex clearance of the bile duct

Cited by 7 publications

References 14 publications

Risk factors and management of primary choledocholithiasis: a systematic review

Risk factors and management of primary choledocholithiasis: a systematic review

Evaluation of Biliary Enteric Anastomosis in Benign Biliary Disorders

Management of Acute Cholangitis

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