Choledochoduodenostomy: reappraisal in the laparoscopic era

With the advent of interventional endoscopic procedures and with growing experience of laparoscopic surgery, the indications for open biliary procedures have become limited. This prospective study reviews the indications of open choledochoduodenostomy for benign biliary diseases and presents the short-term and long-term outcomes of this procedure in the present minimally invasive surgical era.

Side-to-side choledochoduodenostomy was carried out for various benign obstructive pathologies of the biliary tract. The various parameters recorded were the demographic data, indications for surgery, early and late complications and the long-term outcome of the procedure.

Results of choledochoduodenostomy on 54 consecutive patients over a 9-year period are presented. The mean age was 49.7 years with a male to female ratio of 1:2.6. Thirty (55.5%) patients presented with obstructive jaundice and 42.6% had cholangitis. Overall hospital morbidity was 13% with zero mortality. After a mean follow up of 7.8 years, 96.3% patients had 'good' or 'fair' and 3.7% experienced 'poor' results. No recurrent disease or biliary malignancy was observed.

Open biliary drainage procedures may still be indicated in select patients where the facility or expertise for minimally invasive biliary procedures is not available. Choledochoduodenostomy remains an effective biliary drainage procedure with acceptable morbidity and mortality, especially in the high-risk and elderly population. The procedure should be regarded as an essential in the general surgical knowledge and training.