Evaluation of choledochoduodenal anastomosis function in benign biliary obstruction

Ljiljana M Jeremić Savić; Miroslav P Stojanovic; Milan M Radojkovic; Milica Nestorovic

doi:10.2298/VSP1607133373J

Ljiljana M Jeremić Savić Clinic for General Surgery, Clinical Center Nis, Serbia
Miroslav P Stojanovic Clinic for General Surgery, Clinical Center Nis, Serbia
Milan M Radojkovic Clinic for General Surgery, Clinical Center Nis, Serbia
Milica Nestorovic Clinic for General Surgery, Clinical Center Nis, Serbia

DOI: https://doi.org/10.2298/VSP1607133373J

Keywords: anastomosis, surgical, biliary tract surgical procedures, choledochostomy, duodenum, gallstones

Abstract

Abstract

Background/Aim. Choledochoduodenostomy has been reported as an effective treatment of benign biliary obstructions, but associated with a certain percentage of complications, (primarily cholangitis and the “sump” syndrome), as the consequence of duodenobiliary reflux which may occur. The aim of our study was to evaluate the safety, effectiveness and technical feasibility of choledochoduodenostomy for the treatment of distal benign biliary obstruction and to present its minimal postoperative complications. Methods. This propective study included 50 operated patients who had choledochoduodenal anastomosis created for benign biliary obstructions. The symptoms, biochemical and echosonographic parameters of cholestasis, operative technique, recovery features and complications were analayzed and compared. Based on the analysis of obtained data, safety, efficacy and competence of choledochoduodenal anastomosis were determined. Results. Specific early anastomosis-related complications were observed in 12.0% of patients (mostly minor surgical complications). During the immediate postoperative course, aerobilia as an indirect sign of duodenobiliary reflux, occurred in 91.7% of patients, but it was reduced to 16.7% after 30 days (and was not always associated with symptomatology). Choledochoduodenostomy was associated with a low incidence of cholangitis (2%) and anastomosis dehiscence (2%). Transitory duodenogastric reflux was identified in 6% of patients. The rate of intrahospital mortality was very low, considering patients’ very complex conditions (4%). During early postoperative period, the “sump” syndrome was not identified. Conclusion. Choledochoduodenostomy is a simple and effective method in the management of certain types of biliary obstruction. Serious complications can be avoided by proper selection of patients and careful surgical technique. This type od anastomosis has to be included in basic skills of every general surgeon.

Author Biographies

Ljiljana M Jeremić Savić, Clinic for General Surgery, Clinical Center Nis, Serbia

PhD, Departement of hepatobiliary and pancreatic surgery

Miroslav P Stojanovic, Clinic for General Surgery, Clinical Center Nis, Serbia

PhD,Professor of general surgery, Departement of hepatobiliary and pancreatic surgery

Milan M Radojkovic, Clinic for General Surgery, Clinical Center Nis, Serbia

PhD, Departement of hepatobiliary and pancreatic surgery

Milica Nestorovic, Clinic for General Surgery, Clinical Center Nis, Serbia

MSci, Department of colorectal surgery

References

REFERENCES

Jeremić M. Biliary duct surgery. In: Jeremić M, editor. Special surgery 1, diagnostics and therapy. Niš: Faculty of Medicine, Universyti of Niš; 2001. P. 14/1‒14/5.

Pérez Fernández T, López Serrano P, Tomás E, Gutiérrez ML, Lledó JL, Cacho G, et al. Diagnostic and therapeutic ap¬proach to cholestatic liver disease. Rev Esp Enferm Dig 2004; 96(1): 60‒73. (English, Spanish)

Mitchell SA, Jacyna MR, Chadwick S. Common bile duct stones: A controversy revisited. Br J Surg 1993; 80(6): 759‒60.

Aramaki M, Ikeda M, Kawanaka H, Nishijima N, Tsutsumi N, Kano T. Choledochoduodenostomy: Simple side-to-side anas-tomosis. J Hepatobiliary Pancreat Surg 2000; 7(5): 486‒8.

Neoptolemos JP, Radley S.. Long-term results of choledocho-duodenostomy. HPB Surgery 1992; 5(2): 157‒9.

Malik AA, Rather SA, Bari SU, Wani AK. Long-term results of choledochoduodenostomy in benign biliary obstruc¬tion. World J Gastrointest Surg 2012; 4(2): 36‒40.

Madden JL, Chun JY, Kandalaft S, Parekh M. Choledocho-duodenostomy: an unjustly maligned surgical procedure? Am J Surg 1970; 119(1): 45‒54.

Sanders RL. Indications for and value of choledochoduo-denostomy. Ann Surg 1946; 123(5): 847‒58.

Ahrendt SA, Pitt HA. A history of the bilioenteric anastomo¬sis. Arch Surg 1990; 125(11): 1493‒500.

Abdelmajid K, Houssem H, Rafik G, Jarrar MS, Fehmi K. Open Choldecho-Enterostomy for Common Bile Duct Stones: Is it Out of Date in Laparo-Endoscopic Era? N Am J Med Sci 2013; 5(4): 288‒92.

Singh DP, Arora S. Evaluation of biliary enteric anastomo¬sis in benign biliary disordes. Indian J Surg 2014; 76(3): 199‒203.

Ducrotte P, Peillon C, Guillemot F, Testart J, Denis P. Could recurrent cholangitis after Roux-en-Y hepaticojejunostomy be explained by motor intestinal anomalies?, A manomet¬ric study. Am J Gastroenterol 1991; 86(9): 1255‒8.

Li SQ, Liang LJ, Peng BG, Lai JM, Lu MD, Li DM. Hepati-coje¬junostomy for hepatolithiasis: A critical ap¬praisal. World J Gastroenterol 2006; 12(26): 4170‒4.

Di Carlo I, Sauvanet A, Belgihiti J. Intrahepatic lithiasis: A Western expiriance. Surg Today 2000; 30(4): 319‒22.

Costamagna G, Boškoski I. Current treatment of benign bil¬iary strictures. Ann Gastroenterol 2013; 26(1): 37‒40.

Hirano S, Tanaka E, Tsuchikawa T, Matsumoto J, Shichinohe T, Ka-to K. Technique of buliary reconstruction following bile duct resection. J Hepatobiliary Pancreat Sci 2012; 19(3): 203‒9.

El Nakeeb A, Askr W, El Hanafy E, Atef E, Hamdy E, El He-maly M, et al. Long term outcomes of choledochoduo-denostomy for common bile duct stones in the era of laparos-copy and endoscopy. Hepatogastroenterology 2015; 62(137): 6‒10.

de Almeida AC, dos Santos NM, Aldeia FJ. Choledochoduo-denostomy in the management of common duct stones or as-sociated pathology: An obsolete method?. HPB Surg 1996; 10(1): 27‒33.

Leppard WM, Shary TM, Adams DB, Morgan KA, Choledo-choduodenostomy: Is it really so bad. J Gastrointest Surg 2011; 15(5): 754‒7.

Gupta BS. Choledochoduodenostomy: a study of 28 con-secutive cases. Kathmandu Univ Med J (KUMJ) 2004; 2(3): 193‒7.

Zeuge U, Fehr M, Meyenberger C, Sulz MC. Mind teh sump! ‒ diagnostic challenge of rare complication of choledocho-duodenostomy. Case Rep Gastroenterol 2014; 8(3): 358‒63.

Parks RW, Johnston GW, Rowlands BJ. Surgical billiary by¬pass for benign and malignant extrahepatic billiary tract disease. Br J Surg 1997; 84(4): 488‒92.

Tocchi A, Mazzoni G, Liotta G, Lepre L, Cassini D, Miccini M. Late Development of bile duct cancer in patinets who had bi-liary-enteric drainage for benign disease: A follow-up study of more than 1, 000 patients. Ann Surg 2001; 234(2): 210‒4.

Kuran S, Parlak E, Aydog G, Kacar S, Sasmaz N, Ozden A, et al. Bile reflux index after therapeutic biliary procedures. BMC Gastroenterol 2008; 8: 4.

Khalid K, Shafi M, Dar HM, Durrani KM. Choledochoduo-denostomy: Reappraisal in the laparoscopic era. ANZ J Surg 2008; 78(6): 495‒500.

Stein HJ, Smyrk TC, DeMeester TR, Rouse J, Hinder RA. Clinical value of endoscopy and the histology in the diag¬nosis of duodenogastric reflux disease. Surgery 1992; 112(4): 796‒804.

Sobala GM, O'Connor HJ, Dewar EP, King RF, Axon AT, Dixon MF. Bile reflux and intestinal metaplasia in gastric mucosa. J Clin Pathol 1993; 46(3): 235‒40.

Clavien PA, Barkun J, de Oliviera ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: Five-year experience. Ann Surg 2009; 250(2): 187‒96.

Lasnier C, Kohneh-Shahri N, Paineau J. Biliary-enteric anas-tomosis malfunction: retrospective study of 20 surgical cases. Review of literature. Ann Chir 2005; 130(9): 566‒72. (French)