Early and Late Results FollowingCholedochoduodenostomy andCholedochojejunostomy

摘要

Objective —To evaluate the results and complications of choledochoduodenostomyand choledochojejunostomy for benign and malignant disease and to reviewthem in the light of the survival of the underlying disorders.Design —Retrospective analysis of medical records completed by a thoroughinquiry for all patients who were lost to follow-up.Setting —Referrals for primary and secondary surgery for obstructive biliary diseaseto a university hospital from 1974–1987.Patients —After exclusion of patients who underwent a pancreaticoduodenectomyfor cancer (Whipple procedure) 113 patients were included in the study (choledochoduodenostomy =CD, N = 64 and choledochojejunostomy = CJ, N = 49). Acomplete follow-up was achieved in 105 of 113 patients (93%).Interventions —An inquiry was made at the civil registration office if the patientswere alive or not. The general practitioners of the patients who had died werecontacted about the cause of death and the possible biliary symptoms precedingdeath and the patients who were still alive received a questionaire which scrutinizedall possible complications and side effects of the operation.Endpoints —Cholangitis, recurrence of the underlying disease or death of the patient.Measurements and main results —Operative mortality was 4.7% following CD and12.2% following CJ. Procedure-related complications were found in 10.9% and28.6% respectively. Recurrent cholangitis was not seen after CD and in three patientswith a CJ (6.1%). Survival following biliodigestive anastomosis for benign obstructionwas comparable for age and sex matched survival.Conclusions —Although CD for choledocholithiasis has largely been replaced byendoscopic papillotomy and although the choice between the two procedures inmalignant disease is most frequently dictated by the operative findings, we concludethat the choledochoduodenostomy is a relative simple operation with a low risk ofcholangitis.