Choledochoduodenostomy in the treatment of benign biliary tract disease

Recurrent surgical interventions on the biliary system for benign biliary tract diseases carry high morbidity and mortality. Choledochoduodenostomy creates a large and easily performed biliodigestive anastomosis enabling good drainage of the biliary system. Among 27 patients undergoing choledochoduodenostomy for benign biliary tract diseases, recurrent cholangitis occurred in only one patient, in whom a stenosed anastomosis was probably the culprit. The other patients have been free of abdominal complaints, cholangitis, or pancreatitis for follow-up periods of from six months to eight years. There was no operative mortality; morbidity was 45%, but hospital stay averaged only 14.7 days. The traditional objections to this procedure do not seem valid where choledochoduodenostomy is rightly indicated, the common bile duct is dilated, and a wide enough anastomosis is constructed. Our favorable results mark choledochoduodenostomy as a safe, simple, and effective procedure in the management of benign biliary tract disease, particularly in the high risk patient.