[Results of choledoco-duodenostomy for common bile duct lithiasis]

One hundred and sixty-seven choledoco-duodenostomies for lithiasis of the common bile duct (CBD) were performed. The mean age of the patients was 74 +/- 1 years. Sixty p. 100 of the patients presented with at least one operative risk factor, usually related to their general condition. An anastomosis of at least 20 mm in diameter was possible as the diameter of the CBC was always larger than 10 mm. Immediate postoperative complications (within one month) were observed in 29 cases (17 p. 100). In 14 cases (8 p. 100), these complications were directly related to the operative procedure and, in 15 cases (9 p. 100), bronchopulmonary or cardiovascular complications occurred. Operative mortality was 4 p. 100 (7 cases); in 2 cases, death was directly related to the operative procedure, and in 5 cases, death was not directly due to surgery. Operative complications were significantly higher in the case of emergency procedures, impaction of the CBD by multiple stones, and associated acute cholecystitis. One hundred and thirty-four of the 160 survivors (84 p. 100) have been followed for a mean duration of 5 years (63 +/- 7 months); 115 (86 p. 100) have remained asymptomatic. Eleven patients had non specific findings; 8 (6 p. 100) had cholangitis, half of them having suffered from only one episode. The first (or only) episode occurred during the first postoperative year in 7 out of 8 patients. No cholangitis developed after the second postoperative year in patients still asymptomatic. No anastomotic stenosis was found in any of these cases. One case of stump syndrome was observed. These results suggest that choledocoduodenostomy is a reliable procedure for treatment of choledocolithiasis and related late complications are rare.