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Surgery Today
Published in: Surgery Today 4/2024

29-08-2023 | Cholangitis | Original Article

Long-term outcomes of choledochoduodenostomy for choledocholithiasis: increased incidence of postoperative cholangitis after total or distal gastrectomy

Authors: Yasuro Futagawa, Jungo Yasuda, Hironori Shiozaki, Keiichi Ikeda, Shinji Onda, Tomoyoshi Okamoto, Toru Ikegami

Published in: Surgery Today | Issue 4/2024

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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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Metadata
Title
Long-term outcomes of choledochoduodenostomy for choledocholithiasis: increased incidence of postoperative cholangitis after total or distal gastrectomy
Authors
Yasuro Futagawa
Jungo Yasuda
Hironori Shiozaki
Keiichi Ikeda
Shinji Onda
Tomoyoshi Okamoto
Toru Ikegami
Publication date
29-08-2023
Publisher
Springer Nature Singapore
Published in
Surgery Today / Issue 4/2024
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-023-02740-7

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