Choledochoduodenostomy for failed endoscopic treatment of common bile duct stones. Both traditional and current method

Year 2022, , 29 - 32, 01.08.2022

Mehmet Can Aydın , Oğuzhan Özşay , Kağan Karabulut

https://doi.org/10.25000/acem.1101714

Abstract

Background: The gold standard current treatment for common bile duct (CBD) stones is stone extraction via endoscopic retrograde cholangiopancreatography (ERCP). In ERCP failed cases, alternative surgical treatment methods come to the fore. Choledochoduodenostomy (CDD), which is a traditional method, is one of them. We aimed to present our conventional CDD results in ERCP failed patients.
Methods: Between March 2015 and February 2022, clinicodemographics, perioperative findings, and postoperative results of 23 ERCP failed patients with underwent CDD for CBD stones were analyzed retrospecificley
Results: The median age was 71 (41-85), and 13 (56%) were female. Of the patients, 5 (21%) had cholecystectomy and 7 (30%) had gastrectomy + gastroenterostomy, previously. The most common presenting symptom was abdominal pain (39%). The median number of failed ERCPs was 1 (1-6), and the reasons for failure were gastroenterostomy in 7 patients, impacted stones in 9, multiple and/or large stones in 6, and papillary opening anomaly in 1. The median CBD diameter was 15 (10-40) mm. The median operation time was 120 (60-240) minutes, and no perioperative complication developed. The median length of hospital stay was 7 (4-14) days. In the early postoperative period, wound infection was observed in 2 (8%) patients, and evisceration was observed in 1 (4%). There was no mortality. The mean follow-up period was 27 (2-77) months, and incisional hernia was encountered in 2 (8%) patients in the late postoperative period. There was no evidence of Sump syndrome within the follow-up period.
Conclusion: In treatment of ERCP failed CBD stones, CDD is an effective and safe surgical treatment method in selected patients.

Keywords

choledochus, common bile duct exploration, obstructive jaundice

Endoskopik olarak tedavi edilemeyen koledok taşlarında koledokoduodenostomi. Hem geleneksel hem de güncel yöntem

Abstract

Amaç: Koledok taşlarının altın standart güncel tedavi yöntemi endoskopik retrograd kolanjiopankreatografi (ERCP) ile taş çıkarılmasıdır. Bunun başarısız olduğu durumlarda alternatif cerrahi tedavi yöntemleri ön plana çıkmaktadır. Geleneksel bir yöntem olan koledokoduodenostomi (CDD) de bunlardan biridir. Biz de ERCP'nin başarısız olduğu hastalardaki konvansiyonel CDD sonuçlarımızı sunmayı amaçladık.
Yöntemler: Mart 2015 ve Şubat 2022 tarihleri arasında ERCP ile tedavi edilemeyen koledok taşı olan ve konvansiyonel koledok eksplorasyonu, taş çıkarılması ve CDD uygulanan 23 hastanın klinikodemografik verileri, perioperatif bulguları ve postoperatif sonuçları retrospektif olarak analiz edildi.
Bulgular: Hastaların median yaşı 71 (41-85) olup, 13’ü (%56) kadındı. Hastaların 5’inde (21%) geçirilmiş kolesistektomi, 7’sinde (30%) gastrektomi + gastroenterostomi ameliyatı öyküsü vardı. En sık başvuru semptomu karın ağrısıydı (39 %). Başarısız ERCP sayısı median 1 (1-6) olup, başarısızlık nedenleri 7 hastada gastroenterostomi olması, 9 hastada impakte taş olması, 6 hastada taş boyutu ve sayısının fazla olması, 1 hastada da papilla açılım anomalisiydi. Hastaların median koledok çapı 15 (10-40) mm'di. Operasyon süresi median 120 (60-240) dk olup, perioperatif komplikasyon gelişmedi. Yatış süresi median 7 (4-14) gündü. Postoperatif erken dönemde 2 (8%) hastada yara yeri enfeksiyonu, 1 (4%) hastada da eviserasyon görüldü. Mortalite izlenmedi. Hastaların ortalama takip süresi median 27 (2-77) aydı ve geç dönemde 2 (8%) hastada insizyonel herni ile karşılaşıldı. Sump sendromuna ait bulgular hiçbir hastamızda gözlenmedi.
Sonuç: ERCP ile çıkarılamayan koledok taşlarının tedavisinde CDD seçilmiş hastalarda efektif ve güvenli bir cerrahi tedavi yöntemidir.

Keywords

ana hepatik kanal eksplorasyonu, koledok, obstrüktif sarılık

References

• Asad S, Haj Z, Qureshi Z, Gul B, Ahmed S, Khattak IU. Role Of Choledochoduodenostomy Revisited In The Era Of Minimal Invasive Procedures. J Ayub Med Coll Abbottabad. 2019;31:86-9.
• Hungness ES, Soper NJ. Management of common bile duct stones. J Gastrointest Surg. 2006;10:612-9.
• Bektas H, Duzkoylu Y, Cakar E, Buyukasık K, Colak S. Giant choledochal calculosis: surgical treatment. N Am J Med Sci. 2014;6:536-9.
• Berthou JC, Drouard F, Charbonneau P, Moussalier K. Evaluation of laparoscopic management of common bile duct stones in 220 patients. Surg Endosc. 1998;12:16-22.
• Aydın MC, Karahan SR, Kose E. Comparison between laparoscopic and conventional technique in the surgical treatment of choledocholithiasis. Laparosc Endosc Surg Sci. 2020;27:122-9.
• Riedel H. Uber den zungenfoermigen fortastz des rechten lebberlappens und seine pathognostiche bedentung für die, erkrankungen der gallenblose nrbst bemerkungen gallenstein-operationen. Berl Klin Wschr. 1888;25:577–602.
• de Aretxabala X, Bahamondes JC. Choledochoduodenostomy for common bile duct stones. World J Surg. 1998;22:1171-4.
• Konstantakis C, Triantos C, Theopistos V, Theocharis G, Maroulis I, Diamantopoulou G, et al. Recurrence of choledocholithiasis following endoscopic bile duct clearance: Long term results and factors associated with recurrent bile duct stones. World J Gastrointest Endosc. 2017;9:26-33.
• Senthilnathan P, Sharma D, Sabnis SC, Srivatsan Gurumurthy S, Senthil Anand E, Nalankilli VP, et al. Laparoscopic choledochoduodenostomy as a reliable rescue procedure for complicated bile duct stones. Surg Endosc. 2018;32:1828-33.
• Demirel BT, Kekilli M, Onal IK, Parlak E, Disibeyaz S, Kacar S, et al. ERCP experience in patients with choledochoduodenostomy: diagnostic findings and therapeutic management. Surg Endosc. 2011;25:1043-7.
• Okamoto H, Miura K, Itakura J, Fujii H. Current assessment of choledochoduodenostomy: 130 consecutive series. Ann R Coll Surg Engl. 2017;99:545-9.
• Leppard WM, Shary TM, Adams DB, Morgan KA. Choledochoduodenostomy: is it really so bad? J Gastrointest Surg. 2011;15:754-7.
• Srivengadesh G, Kate V, Ananthakrishnan N. Evaluation of long-term results of choledochoduodenostomy for benign biliary obstruction. Trop Gastroenterol. 2003;24:205-7.
• Qadan M, Clarke S, Morrow E, Triadafilopoulos G, Visser B. Sump syndrome as a complication of choledochoduodenostomy. Dig Dis Sci. 2012;57:2011-5.
• Chander J, Mangla V, Vindal A, Lal P, Ramteke VK. Laparoscopic choledochoduodenostomy for biliary stone disease: a single-center 10-year experience. J Laparoendosc Adv Surg Tech A. 2012;22:81-4.
• Khajanchee YS, Cassera MA, Hammill CW, Swanström LL, Hansen PD. Outcomes following laparoscopic choledochoduodenostomy in the management of benign biliary obstruction. J Gastrointest Surg. 2012;16:801-5.