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

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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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Funding

The authors received no funding support for this study.

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Authors and Affiliations

  1. Department of Surgery, The Jikei University Daisan Hospital, 4-11-1 Izumi-honcho, Komae, Tokyo, 201-8601, Japan

    Yasuro Futagawa, Jungo Yasuda, Hironori Shiozaki & Tomoyoshi Okamoto

  2. Department of Endoscopy, The Jikei University Daisan Hospital, 4-11-1 Izumi-honcho, Komae, Tokyo, 201-8601, Japan

    Keiichi Ikeda

  3. Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Shinji Onda & Toru Ikegami

Authors
  1. Yasuro Futagawa
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  2. Jungo Yasuda
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  3. Hironori Shiozaki
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  4. Keiichi Ikeda
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  5. Shinji Onda
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  6. Tomoyoshi Okamoto
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  7. Toru Ikegami
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Contributions

Study conception and design: YF. Acquisition of data: YF, JY, HS, SO, and KI. Analysis and interpretation of data: YF and TO. Manuscript drafted by YF, TO, and TI. All authors provided critical revision during the drafting of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yasuro Futagawa.

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Conflict of interest

The authors declare no conflicts of interest for this article.

Ethical approval

Approval of the research protocol: the protocol for this retrospective study was approved by a suitably constituted Ethics Committee of the institution, and it conforms to the provisions of the Declaration of Helsinki. The Ethics Committee of the Jikei University School of Medicine (Tokyo, Japan) approved this study (Approval No. 27–177).

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Animal studies were not performed.

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Futagawa, Y., Yasuda, J., Shiozaki, H. et al. Long-term outcomes of choledochoduodenostomy for choledocholithiasis: increased incidence of postoperative cholangitis after total or distal gastrectomy. Surg Today 54, 331–339 (2024). https://doi.org/10.1007/s00595-023-02740-7

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  • DOI: https://doi.org/10.1007/s00595-023-02740-7

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