Prevention and treatment of recurrent bile duct stones by choledochoduodenostomy

Abstract

Choledochoduodenostomy is a procedure to be used as an option in certain circumstances and the decision often has to be made at the time of operation. The 2 essential criteria are a dilated common bile duct and an obstruction at its lower end. It may be used at a first operation to prevent recurrent stones if there is clear evidence of a primary duct problem, or at a second operation for recurrent stones when the existence of a duct problem is usually more certain. There are some situations in which choledochoduodenostomy is a genuine alternative to sphincteroplasty. We favor choledochoduodenostomy in obese patients, if there is difficult access to the sphincter, if there is a long stricture as in chronic pancreatitis, when there is suppurative cholangitis, or when the duct is already being explored from above. There is a variety of operative techniques using continuous or interrupted sutures, but it is inadvisable to put nonabsorbable sutures into the lumen of the bile duct. The incision in the duodenum can be longitudinal or transverse, but the duodenum must be rolled up on to the bile duct without tension. The only diet restriction after operation involves avoidance of indigestible particles such as tomato and apple skins and grape pips which may become lodged in the distal bile duct. In the worldwide experience with follow‐up periods of up to 20 years, “ascending” cholangitis has been very rare (about 1%) when the operation was performed correctly with an initial stoma size of at least 2.5 cm.

Is choledochoduodenostomy in the treatment of stones in the common bile duct an obsolete technique?

“…In this way, his or her attention is immediately directed to a wide biliodigestive anastomosis in elderly patients with high surgical risk. We, together with other authors, [32,36,38] are in full agreement with Madden [personal communication] when he says that CDS or transduodenal sphincteroplasty are complementary rather than competitive. We are conscious that duodenoscopic papillotomy has similar objectives but is ineffective when the distal ductal stenosis is very long.…”

“…They have produced excellent results even in high-risk patients. These results have been fully confirmed and published in the last few years [31][32][33][34][35][36][37][38][39]. The purpose of this paper is to report our experience in using CDS in the treatment of CBD stones and to reinforce what is known of the value of the technique.…”

Follow-up studies of surgical treatment for choledocholithiasis.

“…In order to permit residual stones to flow away into the intenstinal canal and/or to eliminate bile stasis, transduodenal sphincteroplasty (Stefanini et al 1974;Jones 1978) and bilioenteric anastomosis (Johnson and Rains 1978;Mudden 1978) are frequently applied as the drainage procedures in the surgical treatment of choledocholithiasis. However, indications of these additional procedures are controversial.…”

Συμβολη Εις Την Μελετην Της Πρωτοπαθους Χοληδοχολιθιασεως

“…Αϋτη είναι κυρίως χειρουργική και περιλαμβάνει τήν προεγχειρητικήν άγωγήν καί τήν έγχείρησιν. (Johnson, 1978).…”