Long-term outcomes of choledochoduodenostomy for hepatolithiasis
Xiao-feng Ling1, Zhi Xu, Li-xin Wang
1Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Insights
Choledochoduodenostomy for hepatolithiasis management did not effectively clear stones or correct strictures. This procedure increased severe reflux cholangitis, indicating it is not ideal for reducing cholangitis in hepatolithiasis.
Area of Science:
- Gastroenterology
- Surgical Management
- Hepatobiliary Diseases
Background:
- The sphincter of Oddi is crucial for preventing reflux cholangitis.
- Choledochoduodenostomy application in hepatolithiasis management remains controversial.
- This study evaluates the long-term outcomes of choledochoduodenostomy in hepatolithiasis treatment.
Purpose of the Study:
- To assess the long-term efficacy of choledochoduodenostomy in hepatolithiasis management.
- To compare pre- and postoperative rates of recurrent and severe acute cholangitis.
- To determine if choledochoduodenostomy alone can resolve hepatobiliary issues.
Main Methods:
- Retrospective analysis of 46 hepatolithiasis cases treated with choledochoduodenostomy.
- Comparison of pre- and postoperative recurrent cholangitis and severe acute cholangitis rates.
- Statistical analysis using the paired chi-square test.
Main Results:
- High rates of remnant stones (39.1%), recurrent stones (31.1%), and uncorrected strictures (85%) were observed.
- Mortality rate was 24.4% with significant food debris regurgitation into the biliary tract.
- Recurrent cholangitis rates remained high (93.3%), and severe acute cholangitis increased significantly (46.7% vs. 20.0%).
Conclusions:
- Choledochoduodenostomy alone is insufficient for complete stone clearance, stricture correction, or hepatobiliary lesion resolution.
- The procedure leads to increased severe reflux cholangitis due to loss of the sphincter of Oddi's anti-reflux function.
- Choledochoduodenostomy is not an ideal approach for reducing cholangitis in hepatolithiasis and is not the preferred management strategy.
Background:
Oddi sphincter plays an important role in preventing reflux cholangitis. There exists the controversy on application of choledochoduodenostomy in hepatolithiasis management. The present study aimed at evaluating long-term outcomes of choledochoduodenostomy for the treatment of hepatolithiasis.
Methods:
Forty-six consecutive cases of hepatolithiasis who underwent choledochoduodenostomy were analyzed retrospectively. The pre- and postoperative rates of recurrent cholangitis and acute cholangitis severe type were compared. Paired chi-square test was applied.
Results:
The mean follow-up time was 17.3 years ranging from 1.6 to 40 years with a follow-up rate of 97.8% (45/46). High rates of remnant stones (39.1%, 18/46), recurrent stones (31.1%, 14/45), uncorrected strictures (85%, 17/20), and mortality (24.4%, 11/45) were observed in this group. Regurgitation of food debris and duodenal content into the biliary tract through the anastomosis was observed. The rate of recurrent cholangitis was equal to the preoperative period (93.3%, 42/45). The rate of acute cholangitis severe type after choledochoduodenostomy (46.7%, 21/45) increased significantly (P<0.01) when compared to the preoperative period (20.0%, 9/45).
Conclusions:
Choledochoduodenostomy did not entirely achieve the goal of clearance of stones, correction of strictures, and removing of hepatobiliary lesions by itself. Choledochoduodenostomy without cholangioplasty resulted in an increase of severe reflux cholangitis due to the loss of the anti-reflux function of the sphincter of Oddi. Therefore, choledochoduodenostomy is not an ideal approach to reduce cholangitis in hepatolithiasis and is not the best choice in the management of hepatolithiasis.
