Choledochoduodenostomy re-evaluated in the endoscopic and laparoscopic era.

Abstract

One of the options for draining an obstructed biliary tree is to form a choledochoduodenostomy (CDD). We evaluate our experience with this procedure with regard to complications (immediate and late), long term patency and patient survival. An analysis was performed on a prospectively maintained database of all patients undergoing CDD under a single surgeon from 1992-2009. Data included pre-operative status, indications for surgery, postoperative morbidity and mortality, and complications. Sixty-eight CDDs were performed (40 male, 28 female). Thirty-seven (54%) were performed for benign disease (group A) and 31 (46%) for malignant disease (histologically confirmed, group B). Patients in group B were older (58 years vs. 69 years, p=0.009), and had higher preoperative bilirubin (58 vs. 156mg/dL, p=0.0003) and alkaline phosphatase (434 vs. 696 U/L, p=0.01). In hospital mortality was 7.5% in group A, and 9% in group B. Patients in group A had a shorter postoperative stay (p=0.008). Long-term mortality was significantly greater in group B (p<0.0001). Long term complications were lower in group A (14%) vs. group B (16%). In group B recurrent jaundice occurred in 3 patients (9.7%), of which 2 were successfully stented at ERCP, and one patient developed ascending cholangitis. CDD remains a relatively safe and effective surgical option for the treatment of obstructive jaundice in both benign and malignant disease. It remains a very useful tool where ERCP has failed, in patients with unresectable pancreatic malignancies, and in patients with recurrent choledocholithiasis.