Long-term complications of side-to-side choledochoduodenostomy: A retrospective study

Objective: To report our experience of complications of side-to-side choledochoduodenostomy (CDD). Design: From 1981 to 1989, 81 patients (28 men and 53 women with a mean age 67.2 ± 1.7 years) underwent endoscopic retrograde cholangiopancreatography (ERCP) for CDD-related complications. Methods: Retrospective analysis of ERCP reports and recollection of data from clinical charts, referring doctors and patients. Results: A period of 4.9 ± 0.6 years elapsed between choledochoduodenostomy and ERCP. Clinical presentation included pain, fever and/or jaundice (81%), septicaemia or hepatic abscesses (12%) or pancreatitis (7%). Symptoms were attributed to a sump syndrome in 46%, supra-anastomotic lithiasis in 12%, bile duct stenosis in 7% and ascending cholangitis in 38%. The anastomosis was stenotic in 32%. Thirty patients were followed up for a period of 2.4 ± 0.5 years; the study of the recurrence rates related to treatment suggested that the appropriate treatments were: endoscopic sphincterotomy in the sump syndrome, endoscopic clearance of the bile duct in supra-anastomotic lithiasis and surgery or endoscopic stenting in bile duct stenosis. Conclusions: After CDD, ERCP showed biliary abnormalities in 62% of symptomatic patients. We suggest that these patients should undergo endoscopic or surgical therapy; if ERCP is normal, such as in ascending cholangitis, conservative treatment seems to be advisable.