Choledechoduodnostomy is an Optional Management for Choledocholithiasis; a Single Center Experience

Document Type : Original Article

Authors

1 Unit of Hepatobiliary Surgery, General Surgery Department, Al Rajhi Liver Hospital, Assiut University, Assiut, Egypt

2 Tropical and Gastroenterology Unit, Al Rajhi Liver Hospital, Assiut University, Assiut, Egypt

Abstract

Background: Endoscopic interventions are the mainstay treatment for choledocholithiasis. However, failure of
stone extraction could be encountered in some cases. Also, some patients may have recurrent stones after previous
endoscopic duct clearance. Choledechoduodenostomy (CDD) may be a good option for these patients. Herein, we
present our experience regarding the safety and efficacy of CDD in the management of such patients.
Patients and methods: We retrospectively reviewed the data of 30 consecutive patients who underwent the
previous procedure in our tertiary care setting. Our main outcome was the incidence of short- and intermediateterm
complications. Patients were followed for a minimum of 18 months after the operation.
Results: Twenty-five patients were performed via the open approach, while the remaining five were performed by
laparoscopy. The majority of cases (93.3%) had a side-to-side anastomosis, while only two cases had an end-toside
anastomosis. Laparoscopy was superior to the open approach in blood loss and hospital stay. However, it was
associated with a significantly prolonged operative time. Regarding postoperative complications, wound infection
was the most common one (33.3%). Other early complications included abdominal collection (10%), bile leakage
(6.7%), ileus (6.7%), and pulmonary embolism (3.3%). Late complications included cholangitis (6.7%), which
responded to medical treatment. No patients with sump syndrome or anastomotic stenosis were encountered
throughout the follow-up period.
Conclusion: Apart from high wound infection rates, CDD is a feasible and effective procedure for the management
of patients with choledocholithiasis, especially after the failure of the endoscopic methods.

Keywords

Ain Shams Journal of Surgery
Volume 16, Issue 4
October 2023
Pages 273-280

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