Choledochoduodenostomy for choledocholithiasis. Indications and functional results

Choledochoduodenostomy in the prevention and treatment of patients with common bile duct stones has been frequently discussed during several years. The introduction of endoscopic sphincterotomy, with excellent results and low morbidity necessitate further examination of the indications for and the value of this procedure as an adjunct to choledocholithotomy. Twenty patients with a mean age of 73 years have been operated on with choledocholithotomy and subsequent choledochoduodenostomy. In 7 of the patients the anastomosis was performed at a primary operation, in 11 at a secondary and in 2 at a third operation. Seven of the patients had primary bile duct stones, while thirteen had multiple stones, either unextractable or with a doubtful clearance. There was no postoperative mortality and only one early complication, a pneumonia. Eighteen of the 20 patients are free of symptoms postoperatively and have normal liver function tests and verified open anastomoses. Two patients had recurrent postoperative cholangitis, one due to a stricture in the anastomosis, which was reoperated, and one due to multiple retained stones intrahepatically despite an open anastomosis. In conclusion choledochoduodenostomy is easy to perform with low morbidity even in old-aged, high-risk patients. It is a safe and effective method in the prevention of retained or recurrent stones.