Laparoscopic choledochoduodenostomy: Role, safety, and efficacy? Our experience of 64 cases

Abstract

Context and Aim: Biliary tract obstruction can be bypassed endoscopically or by laparoscopic bypass. This article aims at analyzing the perioperative outcomes of laparoscopic choledochoduodenostomy (LCDD) performed in a single hospital, in patients not amenable to endoscopic drainage, and compares outcomes from three other case series. This is a retrospective analysis of prospectively gathered data. Materials and Methods: From April 2005 to March 2015, 64 patients with biliary stones and inflammatory or postpancreatitis strictures, refractory to endoscopy, underwent LCDD. The operation was performed using five ports technique. The calculi were first extracted through a vertical supraduodenal choledochotomy, followed by a confirmatory choledochoscopy. The biliary bypass was then constructed with a 2.5-cm choledochoduodenal anastomosis using a double-needle holder technique, single-layer interrupted sutures using 3.0 PDS, or Vicryl. Results: A total of 64 patients underwent LCDD. Nine of these had chronic pancreatitis; the rest had choledocholithiasis with distal stricture. In total, 33 were women and 24 were men, with mean age of 42 years. Mean operative time was 95.9 min, mean blood loss was 160 ml, and mean postoperative length of stay was 4.5 days. There was one minor leak that was managed conservatively. There was no mortality. Follow-up ranged from 1 to 11 years. On a mean follow-up of 58.2 months, there were no long-term complications such as recurrent stones, cholangitis, or sump syndrome. Conclusion: LCDD is an effective method of providing biliary bypass in well-selected patients, with uncommon short- and long-term complications.