Aguirre-Olmedo I, Cuendis-Velázquez A, Morales-Chávez CE, Torres-Ruiz MF, Rojano-Rodríguez ME, Cárdenas-Lailson LE

Language: Spanish
References: 17
Page: 118-124
PDF size: 1058.29 Kb.

ABSTRACT

Introduction: Choledochoduodenostomy is indicated for unsolved choledocholithiasis and biliary malignant or benign stenosis. This surgical procedure has been feared for its potential complications. This article shows our initial experience with this laparo-endoscopic approach.
Methods: We performed laparoscopic choledochoduodenoastomy in seven elderly patients with recurrent or unsolved choledocholithiasis. Additionally, laparo-endoscopic extraction of gallstones was performed in necessary cases. We gathered and analyzed the demographic data, diagnostic proofs and follow up of the patients.
Results: Average age of patients was 71 years, with 57.1% of women in our population. Main comorbidities of our patients included obesity in 71.4%, diabetes mellitus type 2 in 57.4%, and arterial hypertension in 42.85%. Patients had in average 2.7 previous episodes of choledocholithiasis and/or cholangitis and the average diameter of the removed stones was 22.6 mm. Average follow-up was 155 days (range 28 to 420).
Discussion: Laparoscopic chooledochoduodenostomy has proved to be safe, effective and be superior to open surgery, as long as an appropriate selection of patients is performed and surgeons with experience on laparoscopic techniques are available. All these factors reduce the long-term complications with which this surgical procedure has been related.
Conclusions: Laparoscopic choledochoduodenostomy is an option for the definitive surgical treatment of “difficult choledocholithiasis” in elderly patients with multiple comorbidities; it also offers the advantages of the minimally invasive approaches.

REFERENCES

1. Leppard MW, Shary TM, Adams DB, Morgan KA. Choledochoduodenostomy: Is it Really So Bad? J Gastrointest Surg 2011;15(5):754-757.

2. Pappas T, Voss M. Choledochoduodenostomy. In: Clavien PA, Sarr MG, Fong Y, editors. Atlas of Upper Gastrointestinal and Hepato- Pancreato-Biliary Surgery. Berlin; Springer 2007;XXVIII p. 623- 630.

3. Jeyapalan M, Almeida JA, Michaelson RLP, Franklin ME Jr. Laparoscopic Choledochoduodenostomy: Review of a 4-Year Experience With an Uncommon Problem. Surg Laparosc Endosc Percutan Tech 2002;12(3):148-153.

4. Franklin ME, Balli JE. Laparoscopic Common Bile Duct Bypass Procedures. Semin Laparoscop Surg 1997;4(1):48-53.

5. 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(4):1043-1047.

6. Qadan M, Clarke S, Morrow E, Triadafilopoulos G, Visser B. Sump Syndrome as a Complication of Choledochoduodenostomy. Dig Dis Sci 2012;57:2011-2015.

7. Bennett W, Zimmerman MA, Campsen J, Mandell MS, Bak T, Wachs M, et al. Choledochoduodenostomy is a Safe Alternative to Rouxen- Y Choledochojejunostomy for Biliary Reconstruction in Liver Transplantation. World J Surg 2009;33(5):1022-1025.

8. Wigmore SJ. Choledochoduodenostomy as an Alternative to Choledochojejunostomy in Liver Transplantation. World J Surg 2009;33:1026-1027.

9. Escudero-Fabre A, Escallon AJ Jr, Sack J, Halpern NB, Aldrete JS. Choledochoduodenostomy. Analysis of 71 Cases Followed for 5 to 15 years. Ann Surg 1991;213(6):635-642.

10. Zafar SN, Khan MR, Raza R, Khan MN, Kasi M, Rafiq A, et al. Early complications after biliary enteric anastomosis for benign diseases: A retrospective analysis. BMC Surgery 2011;11:19-23.

11. Deutsch AA, Nudelman I, Gutman H, Reiss R. Choledochoduodenostomy an Important Surgical Tool in the Management of Common Bile Duct Stones. A Review of 126 Cases. Eur J Surg 1991;157(9):531-533.

12. Birkenfeld S, Serour F, Levi S, Abulafia A, Balassiano M, Krispin M. Choledochoduodenostomy for benign and malignant biliary tract diseases. Surgery 1988;103(4):408-410.

13. Kinami Y, Takata M, Yamamoto H, Saito H, Aonuma K, Takashima S. Operative Results of Side-To-Side Choledochoduodenostomy for Cholelithiasis. Dig Surg 1987;4(2):110-116.

14. Venerito M, Fry LC, Rickes S, Malfertheiner P, Mönkemüller K. Cholangitis as a late complication of choledochoduodenostomy: the sump syndrome. Endoscopy 2009;41(Suppl 2):E142-E143.

15. Toumi Z, Aljarabah M, Ammori BJ. Role of the laparoscopic approach to biliary bypass for benign and malignant biliary diseases: a systematic review. Surg Endosc 2011;25(7):2105-2116.

16. Rhodes M, Nathanson L. Laparoscopic choledochoduodenostomy. Surg Laparosc Endosc 1996;6(4):318-321.

17. 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(1):81-84.