Choledochoduodenostomy for choledocholithiasis

ABSTRACT

Choledochoduodenostomy as a method for prevention and treatment of common bile stones has been frequently discussed during the last few years. The introduction of endoscopic sphincterotomy, with excellent results and low morbidity necessitate further evaluation of the indications and the value of this procedure. Thirty [30] patients with a mean age of 56 years have been operated on with choledocholithotomy and subsequent Choledochoduodenostomy. In nineteen [19] of the patients the anastomosis was performed at the primary operation, in eleven [11] at a secondary operation. Ten [10] of the patients had primary bile duct stones, while twenty had multiple stones, either unextractable or with a doubtful clearance. There was no postoperative mortality and only one early complication, a pneumonia. Twenty eight of the 30 patients are free of symptoms postoperatively and have normal liver function tests, and verified open anastomosis. Two patients had recurrent postoperative cholangitis, one due to stricture at the site of anastomosis which was reoperated, and one due to multiple retained stones intrahepatically despite an open anastomosis. In conclusion Choledochoduodenostomy is easy to perform with low morbidity even in old age, high risk patients. It is a safe and effective method in the prevention of retained or recurrent stones