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

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

Öz

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.

Anahtar Kelimeler

• ana hepatik kanal eksplorasyonu
• koledok
• obstrüktif sarılık

Kaynakça

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