LONG-TERM COMPLICATIONS OF SIDE-TO-SIDE CHOLEDOCHODUODENOSTOMY - A RETROSPECTIVE STUDY

Objective: To report our experience of complications of side-to-side c holedochoduodenostomy (CDD). Design: From 1981 to 1989, 81 patients (2 8 men and 53 women with a mean age 67.2 +/- 1.7 years) underwent endos copic retrograde cholangiopancreatography (ERCP) for CDD-related compl ications. Methods: Retrospective analysis of ERCP reports and recollec tion of data from clinical charts, referring doctors and patients. Res ults: A period of 4.9 +/- 0.6 years elapsed between choledochoduodenos tomy and ERCP. Clinical presentation included pain, fever and/or jaund ice (81%), septicaemia or hepatic abscesses (12%) or pancreatitis (7%) . Symptoms were attributed to a sump syndrome in 46%, supra-anastomoti c lithiasis in 12%, bile duct stenosis in 7% and ascending cholangitis in 38%. The anastomosis was stenotic in 32%. Thirty patients were fol lowed up for a period of 2.4 +/- 0.5 years; the study of the recurrenc e rates related to treatment suggested that the appropriate treatments were: endoscopic sphincterotomy in the sump syndrome, endoscopic clea rance of the bile duct in supra-anastomotic lithiasis and surgery or e ndoscopic stenting in bile duct stenosis. Conclusions: After CDD, ERCP showed biliary abnormalities in 62% of symptomatic patients. We sugge st that these patients should undergo endoscopic or surgical therapy; if ERCP is normal, such as in ascending cholangitis, conservative trea tment seems to be advisable.