Evaluation of choledochoduodenal anastomosis in benign biliary obstruction

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.