LONG-TERM RESULTS OF CHOLEDOCHODUODENOSTOMY VERSUS CHOLEDOCHOJEJUNOSTOMY FOR CHOLEDOCHOLITHIASIS

The current randomized study was done to compare the results of choled ochoduodenostomy (CD) and choledochojejunostomy (CJ) for choledocholit hiasis, with special reference to long term results and the risk of as cendant cholangitis. From january 1978 to January 1990, 130 patients w ere included in the study-64 with CD (side to side, in all patients) a nd 66 with CJ (side to side in 25 patients and end to side in 41). No significant difference was observed between the CD and CJ groups for p ostoperative mortality (3.8 percent) and morbidity rates. One hundred and twenty patients (58 CD and 62 CJ) were available for long term fol low-up evaluation (mean follow-up period of 29+/-11 months). One hundr ed and seven patients had no symptoms attributable to biliary disease or operation. Five patients in this group died of unrelated causes. Th irteen patients experienced biliary symptoms suggestive of cholangitis , or at least related to the bilioenteric anastomosis-six patients in the CD group and seven in the CJ group. Cholangitis was observed in th e first postoperative year in eight of these 13 patients and during th e second year for the five others. In the CD group, cholangitis was th e result of sump syndrome (n=3), anastomotic stricture (n=1) and unkno wn causes (n=2). In the CJ group, cholangitis was die result of anasto motic stricture (n=3), residual intrahepatic stones (n=1) and unknown causes (n=3). The results of the current study confirm the good long t erm results of both procedures. However, it suggests that CD is prefer able for choledocholithiasis for two reasons-it is technically easier and faster to perform than CJ and, unlike CJ, CD permits easy access t o further endoscopic exploration or treatment if necessary.