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Comparing Laparoscopic and Open Choledochoduodenostomy At a Single Institution
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DOI：10.1097/SLE.0000000000001426.png)
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Abstract
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Background:Choledochoduodenostomy (CDD) has been reconsidered as an alternative to choledocholithiasis, especially in cases where endoscopic clearance is difficult. This study aimed to evaluate the use of laparoscopic CDD and compare the results with open CDD, including long-term outcomes.Methods:The medical records of 65 patients who underwent laparoscopic or open surgery due to the difficulty of endoscopic treatment between 2011 and 2021 were retrospectively analyzed. Laparoscopic CDD was performed in 20 cases during the latter period, from April 2016, and open CDD was performed in 45 cases during the former period, before April 2016. The laparoscopic and open CDD surgical results were compared. Data on patient demographics, operative time, blood loss, hospital stay, and complications like bile leakage, reflux cholangitis, and anastomosis stenosis were evaluated.Results:The median operative times, blood losses, and hospital stays were 187 and 125 minutes, 32 and 95 mL, and 8 and 14 days in the laparoscopic and open CDD groups, respectively. The occurrence of minor bile leakage, reflux cholangitis, and anastomosis stenosis was 2/20 (10%) and 1/45 (2.2%), 1/20 (5%) and 2/45 (4.4%), and 2/20 (10%) and 1/45 (2.2%) in the laparoscopic and open CDD groups, respectively. A comparison between the laparoscopic and open CDD groups revealed no significant difference in reflux cholangitis or anastomosis stenosis, but the operative times and incidence of minor bile leakage were higher in the laparoscopic group, and the hospital stays and amount of blood loss were lower in the laparoscopic group.Conclusions:Laparoscopic CDD is feasible and not inferior to open CDD. The laparoscopic approach is minimally invasive and may be particularly advantageous in some patients.
Keywords:
laparoscopic choledochoduodenostomy
minimally invasive surgery
endoscopic clearance difficult stone
choledochal dilatation
biliary enteric anastomosis
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