Choledochoduodenostomy versus hepaticojejunostomy - a matched case-control analysis

Area of Science:

• Gastroenterology
• Biliary Surgery
• Surgical Outcomes

Background:

• Choledochoduodenostomy (CD) is associated with potential long-term issues like sump syndrome and reflux gastritis.
• Roux-and-Y hepaticojejunostomy (HJ) is often considered a superior alternative to CD.
• This study aimed to compare short- and long-term outcomes of CD versus HJ for benign biliary conditions.

Purpose of the Study:

• To compare the short-term and long-term outcomes of choledochoduodenostomy (CD) and Roux-and-Y hepaticojejunostomy (HJ).
• To evaluate the incidence of specific complications, including sump syndrome and anastomotic strictures, following these procedures.
• To determine the preferred surgical approach for benign biliary diseases requiring biliary-digestive anastomosis.

Main Methods:

• Retrospective, matched case-control study.
• Involved patients undergoing biliary-digestive anastomosis for benign diseases between 2000 and 2016.
• Matched patients 1:1 based on age, sex, ASA classification, indication, and surgical history.

Main Results:

• Overall morbidity was comparable between HJ and CD groups (30.8% vs. 26.9%).
• Long-term complications were higher in the CD group (50%) compared to the HJ group (23.1%).
• Anastomotic strictures were significantly more frequent after CD, requiring surgical re-intervention (p=0.016).

Conclusions:

• While short-term complications are similar, CD leads to a higher rate of anastomotic strictures.
• Roux-and-Y hepaticojejunostomy (HJ) is the preferred biliary bypass procedure.
• Choledochoduodenostomy (CD) should be reserved for carefully selected patients.