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Futagawa Y, Yasuda J, Shiozaki H, Ikeda K, Onda S, Okamoto T, Ikegami T. Long-term outcomes of choledochoduodenostomy for choledocholithiasis: increased incidence of postoperative cholangitis after total or distal gastrectomy. Surg Today 2024; 54:331-339. [PMID: 37642741 DOI: 10.1007/s00595-023-02740-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/16/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Choledochoduodenostomy (CDD) is performed to treat choledocholithiasis (CDL) cases where endoscopic stone removal is difficult. Recognizing CDD characteristics is important for CDL treatment planning. METHODS A total of 116 patients, including 33 patients ≥ 80 years old (29 with previous total gastrectomy, 19 with previous distal gastrectomy, 20 with built-up stones, 19 with periampullary diverticulum, 10 with confluence stones, 8 with repetitive recurrent stones, 4 with hard stones, 3 with endoscopic retrograde cholangiography [ERC] not available due to lack of cooperation, 2 with a history of pancreatitis post-ERC, and 2 in whom ERC could not be performed due to a disturbed anatomy) underwent CDD for CDL. Postoperative complications and long-term outcomes were evaluated. RESULTS The in-hospital mortality rate was 0%. The morbidity (grade ≥ IIIA according to the Clavien-Dindo classification) rates in the elderly (≥ 80 years old) and non-elderly (51-79 years old) patients were 3.0% (1/33) and 2.4% (2/83), respectively (p = 0.85). Long-term complications included cholangitis in eight (7%) patients, of which three cases were repetitive and seven had an operative history of total or distal gastrectomy. The incidence of postoperative cholangitis after total or distal gastrectomy was 15% (7/48), which was significantly higher than that involving other causes (1.5%, 1/68; p < 0.01). Two patients with cholangitis after total gastrectomy experienced early recurrence of lithiasis at 2 and 9 months after surgery. CONCLUSIONS CDD is safe, even in elderly patients. However, a history of total gastrectomy or distal gastrectomy may increase the incidence of postoperative cholangitis.
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Affiliation(s)
- Yasuro Futagawa
- Department of Surgery, The Jikei University Daisan Hospital, 4-11-1 Izumi-honcho, Komae, Tokyo, 201-8601, Japan.
| | - Jungo Yasuda
- Department of Surgery, The Jikei University Daisan Hospital, 4-11-1 Izumi-honcho, Komae, Tokyo, 201-8601, Japan
| | - Hironori Shiozaki
- Department of Surgery, The Jikei University Daisan Hospital, 4-11-1 Izumi-honcho, Komae, Tokyo, 201-8601, Japan
| | - Keiichi Ikeda
- Department of Endoscopy, The Jikei University Daisan Hospital, 4-11-1 Izumi-honcho, Komae, Tokyo, 201-8601, Japan
| | - Shinji Onda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Tomoyoshi Okamoto
- Department of Surgery, The Jikei University Daisan Hospital, 4-11-1 Izumi-honcho, Komae, Tokyo, 201-8601, Japan
| | - Toru Ikegami
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
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Harbhajan Singh TS, Seang S, Roy SP, Majid A. Laparoscopic choledochotomy and choledochoduodenostomy for the management of persistent common bile duct stones. SAGE Open Med Case Rep 2022; 10:2050313X221128093. [PMID: 36199808 PMCID: PMC9527980 DOI: 10.1177/2050313x221128093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Choledochotomy and choledochoduodenostomy were commonly used technique in the early twentieth century to extract bile duct stones. Endoscopic retrograde cholangiopancreatography and sphincterotomy revolutionised the scenario and is currently the preferred first-line option for managing choledocholithiasis. However, in certain circumstances, where endoscopic retrograde cholangiopancreatography fails, choledochotomy and choledochoduodenostomy are the only available options. We present the case of an 86-year-old female with a background of multiple previous presentations with biliary sepsis and ascending cholangitis requiring multiple endoscopic retrograde cholangiopancreatographies that failed to remove all stones in the common bile duct. She underwent a laparoscopic choledochotomy and choledochoduodenostomy that successfully resolved her common bile duct obstruction. Laparoscopic choledochotomy and choledochoduodenostomy reduce the length of hospital stay and help to minimise complications associated with open surgery.
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Affiliation(s)
| | | | - Susmit Prosun Roy
- Department of Surgery, Calvary Mater Hospital, Newcastle, NSW, Australia
- School of Medicine and Surgery, University of Newcastle, Newcastle, NSW, Australia
| | - Adeeb Majid
- Department of Surgery, Calvary Mater Hospital, Newcastle, NSW, Australia
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Cuendis-Velázquez A, E. Trejo-Ávila M, Rosales-Castañeda E, Cárdenas-Lailson E, E. Rojano-Rodríguez M, Romero-Loera S, A. Sanjuan-Martínez C, Moreno-Portillo M. Colédoco-duodeno anastomosis laparoscópica. Cir Esp 2017; 95:397-402. [DOI: 10.1016/j.ciresp.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/22/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
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Eskander MF, Bliss LA, Yousafzai OK, de Geus SWL, Ng SC, Callery MP, Kent TS, Moser AJ, Khwaja K, Tseng JF. A nationwide assessment of outcomes after bile duct reconstruction. HPB (Oxford) 2015; 17:753-62. [PMID: 26096061 PMCID: PMC4557648 DOI: 10.1111/hpb.12436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/01/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bile duct reconstruction (BDR) is used to manage benign and malignant neoplasms, congenital anomalies, bile duct injuries and other non-malignant diseases. BDR outcomes overall, by year, and by indication were compared. METHODS Retrospective analysis of Nationwide Inpatient Sample discharges (2004-2011) including ICD-9 codes for BDR. All statistical testing was performed using survey weighting. Univariate analysis of admission characteristics by chi square testing. Multivariate modelling for inpatient complications and inpatient death by logistic regression. RESULTS Identified 67 160 weighted patient admissions: 2.5% congenital anomaly, 37.4% malignant neoplasm, 2.3% benign neoplasm, 9.9% biliary injury, 47.9% other non-malignant disease. Most BDRs were performed in teaching hospitals (69.6%) but only 25% at centres with a BDR volume more than 35/year. 32.3% involved ≥ 1 complication, and 84.7% were discharges home. There was a 4.2% inpatient death rate. The complication rate increased but the inpatient death rate decreased over time. The rates of acute renal failure increased. Significant multivariate predictors of inpatient death include indication of biliary injury or malignancy, and predictors of any complication include public insurance and non-elective admission. CONCLUSION This is the first national description of BDRs using a large database. In this diverse sampling, both procedure indication and patient characteristics influence morbidity and mortality.
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Affiliation(s)
- Mariam F Eskander
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lindsay A Bliss
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Osman K Yousafzai
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Susanna W L de Geus
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sing Chau Ng
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mark P Callery
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tara S Kent
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A James Moser
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Khalid Khwaja
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jennifer F Tseng
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Abdelmajid K, Houssem H, Rafik G, Jarrar MS, Fehmi H. Open Choldecho-Enterostomy for Common Bile Duct Stones: Is it Out of Date in Laparo-Endoscopic Era? NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:288-92. [PMID: 23724404 PMCID: PMC3662096 DOI: 10.4103/1947-2714.110438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Nowadays, biliary-enteric drainage (BED) is regarded as a last resort or obsolete therapeutic method for common bile duct stone (CBDS) not only because of advances in minimally invasive therapeutic modalities but also due to fears of higher morbidity, cholangitis, and “sump” syndrome. Aim: The present study aimed at evaluating the outcome of this procedure for choledocholithiasis. Materials and Methods: It is a retrospective review of 51 patients who underwent open choledochoenterostomy for CBDS between January 2005 and December 2009. Results: About 40 women (78%) and 11 men underwent open BED (mean age 72 years). Indications were elderly patients (90%), multiple stones (54.9%) and unextractable calculi (15.4%). We performed 49 (96%) side to side choledochoduodenostomies, one end to side choledochoduodenostomy (CDS) and one end to side hepaticojejunostomy. The mortality rate was 3.9%. Overall morbidity was 12% with no biliary leakage. With a decline of 1-6 years, neither sump syndrome nor cholangiocarcinoma occurred. Conclusions: Side-to-side CDS is a safe and highly effective therapeutic measure, even when performed on ducts less than 15 mm wide, provided a few technical requirements are respected. Patients experiencing relapsing cholangitis after BED should be closely monitored for the late development of biliary tract malignancies.
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Affiliation(s)
- Khnissi Abdelmajid
- Department of General Surgery, Professor Rached Letaief at Farhat Hached Hospital, Sousse, Tunisia
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Mehler SJ. Complications of the extrahepatic biliary surgery in companion animals. Vet Clin North Am Small Anim Pract 2011; 41:949-67, vi. [PMID: 21889694 DOI: 10.1016/j.cvsm.2011.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Surgery of the biliary tract is demanding and is associated with several potentially life-threatening complications. Veterinarians face challenges in obtaining accurate diagnosis of biliary disease, surgical decision-making, surgical hemostasis and bile peritonitis. Intensive perioperative monitoring is required to achieve early recognition of common postoperative complications. Proper treatment and ideally, avoidance of surgical complications can be achieved by gaining a clear understanding physiology, anatomy, and the indications for hepatobiliary surgery.
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Affiliation(s)
- Stephen J Mehler
- Veterinary Specialists of Rochester, 825 White Spruce Boulevard, Rochester, NY 14623, USA.
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Koea JB. Evolution: occasional revolution. ANZ J Surg 2008; 78:424-5. [PMID: 18522556 DOI: 10.1111/j.1445-2197.2008.04527.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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