ROLE OF CHOLEDOCHODUODENOSTOMY REVISITED IN THE ERA OF MINIMAL INVASIVE PROCEDURES
AbstractBackground: Present era of endoscopic and laparoscopic approaches have revolutionized surgical management of Common Bile Duct (CBD) stones. Open procedures like Choledochoduodenostomy (CDD) have become a rarity but are not completely obsolete. It may be considered a relatively safe alternative when dealing with recurrent, too large or impacted stones, a failed ERCP, and CBD stricture with stones. The aim of this study was to establish safety, efficiency, cost effectiveness and easy availability of CDD in selected patients. Methods: In this observational study, the outcome of 90 consecutive patients undergoing CDD between 1st January 1995 and 31st Dec, 2016 in surgical unit C, Ayub Medical Complex, Abbottabad was reviewed. Choledochoduodenostomy was offered to patients who refused or had a failed ERCP and when CBD size was more than 1cm. CBD was anastomosed to Duodenum using standard technique. Results: Medical records of 90 patients (age range 34–96 years) were reviewed; 5 were excluded and 85 were included in the study. Complication rate was 31.76% (n=27) including respiratory complications in 16.47% (n=14), wound infection in 10.6% (n=9), anastomotic leak in 2.35% (n=2) and Cholangitis in 1.18% (n=1) and Mortality in 1.18% (n=1). There was no evidence of Sump Syndrome. Total cost of procedure was Rs.50 as admission fee, which included daily provision of food and there were no room charges. Conclusion: Choledochoduodenostomy is a safe procedure, with fewer complications and significantly low cost. In case of ERCP failure, CDD is recommended.Keywords: Choledochoduodenostomy; failed ERCP; Open Surgery; safe; Sump Syndrome; Reflux Cholangitis
Canena J. Once upon a Time a Guideline Was Used for the Evaluation of Suspected Choledocholithiasis: A Fairy Tale or a Nightmare. GE Port J Gastroenterol 2018;25(1):6–9.
Magalhães J, Rosa B, Cotter J. Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: From guidelines to clinical practice. World J Gastrointest Endosc 2015;7(2):128–34.
Ghazal AH, Sorour MA, El-Riwini M, El-Bahrawy H. Single-step treatment of gall bladder and bile duct stones: A combined endoscopic–laparoscopic technique. Int J Surg 2009;7(4):338–46.
Sarli L, Pietra N, Franzé A, Colla G, Costi R, Gobbi S, et al. Routine intravenous cholangiography, selective ERCP, and endoscopic treatment of bile duct stones before laparoscopic cholecystectomy. Gastrointest Endosc 1999;50(2):200–8.
Gollan JL, Bulkley GB, Diehl AM, Elashoff JD, Federle MP, Hogan WJ, et al. NIH Consensus conference. Gallstones and laparoscopic cholecystectomy. JAMA 1993;269(8):1018–24.
Kim DI, Kim MH, Lee SK, Seo DW, Choi WB, Lee SS, et al. Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy. Gastrointest Endosc 2001;54(1):42–8.
Konstantakis C, Triantos C, Theopistos V, Theocharis G, Maroulis I, Diamantopoulou G, et al. Recurrence of choledocholithiasis following endoscopic bile duct clearance: long term results and factors associated with recurrent bile duct stones. World J Gastrointest Endosc 2017;9(1):26–33.
Trikudanathan G, Navaneethan U, Parsi MA. Endoscopic management of difficult common bile duct stones. World J Gastroenterol 2013;19(2):165–73.
Nzenza TC, Al-Habbal Y, Guerra GR, Manolas S, Yong T, McQuillan T. Recurrent common bile duct stones as a late complication of endoscopic sphincterotomy. BMC Gastroenterol 2018;18(1):39.
Bektas H, Duzkoylu Y, Cakar E, Buyukasık K, Colak S. Giant choledochal calculosis: surgical treatment. N Am J Med Sci 2014;6(10):536–9.
Berthou JC, Drouard F, Charbonneau P, Moussalier K. Evaluation of laparoscopic management of common bile duct stones in 220 patients. Surg Endosc 1998;12(1):16–22.
Berci G, Morgenstern L. Laparoscopic management of common bile duct stones. Surg Endosc 1994;8(10):1168–75.
de Aretxabala X, Bahamondes JC. Choledochoduodenostomy for common bile duct stones. World J Surg 1998;22(11):1171–4.
Malik AA, Rather SA, Bari SU, Wani KA. Long-term results of choledochoduodenostomy in benign biliary obstruction. World J Gastrointest Surg 2012;4(2):36–40.
Aramaki M, Ikeda M, Kawanaka H, Nishijima N, Tsutsumi N, Kano T. Choledochoduodenostomy: simple side‐to‐side anastomosis. J Hepatobiliary Pancreat Surg 2000;7(5):486–8.
Abraham H, Thomas S, Srivastava A. Sump Syndrome: A Rare Long-Term Complication of Choledochoduodenostomy. Case Rep Gastroenterol 2017;11(2):428–33.
Qadan M, Clarke S, Morrow E, Triadafilopoulos G, Visser B. Sump syndrome as a complication of choledochoduodenostomy. Dig Dis Sci 2012;57(8):2011–5.
Block MA, Brush BE, Ponka JL, Chepeau A. Stenosis of the sphincter of Oddi as a cause of jaundice. AMA Arch Surg 1958;76(6):888–94.
Martin DJ, Vernon D, Toouli J. Surgical versus endoscopic treatment of bile duct stones. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2006.
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