Evaluation of long-term results of choledochoduodenostomy for benign biliary obstruction

The role of choledochoduodenostomy (CDD) in the management of lower common bile duct (CBD) obstruction is controversial because of the long-term complications such as ascending cholangitis, sump syndrome and alkaline reflux gastritis. In spite of the good long-term results observed in some studies, CDD is considered a last trial for lower CBD obstruction. This study was done to analyze the efficacy and long-term results observed in patients who underwent CDD. A total of 21 patients who underwent side-to-side CDD for various causes of lower CBD obstruction from 1992 to 2002 in our institute were analyzed retrospectively. Symptoms, indications and complications were noted from the hospital records. Long-term follow-up evaluation was done through personal communication, examination, and subsequent ultrasonography and endoscopy in symptomatic patients. The most common presenting symptom was abdominal pain (95.2%) and the most frequent indication for CDD was multiple CBD stones (61.9%). Eighteen of the 21 patients (85.7%) had a normal postoperative recovery without any complications. One patient (4.8%) had an anastomotic leak and peritonitis, and 2 (9.5%) had wound infection. Long-term follow-up was possible in only 15 patients as the others were lost to follow-up. Nine patients (60%) were asymptomatic and 6 (40%) were occasionally symptomatic (abdominal pain and bilious vomiting), to an extent which did not affect their day-to-day life. Recurrent or retained stones were not noted, in any patient. All 6 symptomatic patients showed duodenogastric reflux but alkaline reflux gastritis was seen in only 1 patient (6.66%). Anastomotic stoma was patent in all the patients subjected to endoscopy. Features of cholangitis or sump syndrome were not noted in any patient. Side-to-side CDD is a safe and definitive procedure for the decompression of lower CBD obstruction. It has good long term results with infrequent complications.