Operative Results of Side-To-Side Choledochoduodenostomy for Cholelithiasis

Abstract

To clarify the clinical problems of side-to-side choledochoduodenostomy as an adjunct to surgical management of cholelithiasis, the operative results of 82 patients treated in our clinic during the past 10 years were studied. There were 73 patients with extrahepatic bile duct stone and 9 with intra- and extrahepatic bile duct stone. Their mean age was 64 years, and the ratio of males to females was 1.2:1. The operative mortality rate was 4.9%; early complications developed in 7% of the patients. Of all patients who were discharged, 32% developed late complications, and 22%, including 3 patients with sump syndrome, revealed ascending cholangitis. During follow-up, 13 patients died, 6 of them of cholangitis. A relationship between the occurrence of cholangitis and the size of anastomosis was investigated, but there was no obvious connection between them. Six (7.3%) patients underwent reoperations caused by cholangitis, residual or recurrent stones and stenosis of anastomosis. Good to excellent long-term results were seen in 78% of all patients, while fair to poor results were observed in the rest. Especially, results in patients with intra- and extrahepatic bile duct stones were poor. These results suggest that it is necessary to carefully consider the indication of this procedure for patients with cholelithiasis.

ERCP experience in patients with choledochoduodenostomy: diagnostic findings and therapeutic management

“…On the other hand, inconsistent complication rates have been reported in the literature. The total biliary complication rate was less than 5% in two series [5,6], whereas it was more than 20% in another group of patients [7].…”