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Updated: Dec 8, 2025
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Choledochoduodenostomy versus hepaticojejunostomy - a matched case-control analysis
A Marthe Schreuder1, Lotte C Franken1, Susan van Dieren1
1Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
Insights
Roux-and-Y hepaticojejunostomy (HJ) is superior to choledochoduodenostomy (CD) for benign biliary diseases, showing fewer long-term complications and anastomotic strictures. HJ is recommended as the preferred biliary bypass, with CD reserved for select cases.
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.
Background:
Choledochoduodenostomy (CD) is believed to cause certain long-term complications, such as sump syndrome and reflux gastritis. Therefore, CD is considered inferior to a Roux-and-Y hepaticojejunostomy (HJ). The aim of this study was to compare short- and long-term outcomes following CD and HJ for benign biliary diseases.
Methods:
This was a retrospective, matched case-control study of patients undergoing biliary-digestive anastomosis for benign diseases between 2000 and 2016 in a tertiary centre. Patients undergoing CD and HJ were matched 1:1 based on age, sex, ASA-classification, indication, history of abdominal surgery or acute cholecystitis/pancreatitis. Short- and long-term outcomes were compared.
Results:
Of 336 patients undergoing biliary-digestive anastomoses, 27 patients underwent CD. Matching resulted in two comparable groups of 26 patients each. Overall morbidity after HJ and CD was comparable: 30.8% versus 26.9% (p>0.999). Long-term complications occurred in 23.1% after HJ, and in 50% after CD (p=0.118). After CD, 2 patients (7.7%) developed sump syndrome. Both patients with an anastomotic stricture after HJ could be managed by endoscopic/radiological re-intervention, whilst all six patients with a stricture after CD required surgical re-intervention (p=0.016).
Conclusion:
Although short-term complications were comparable, the number of anastomotic strictures was higher in patients undergoing CD. We therefore conclude that HJ is the biliary bypass of choice while CD should be performed in selected patients only.
