Surgical approaches to recurrent choledocholithiasis. Choledochoduodenostomy versus T-tube drainage after choledochotomy.
To assess the value of choledochoduodenostomy versus T-tube drainage to manage patients with recurrent choledocholithiasis, a prospective, randomized study was carried out where under strict criteria of selection, 45 patients underwent choledochoduodenostomy after choledochotomy (Group A), and another 45 patients underwent T-tube drainage (Group B). Results revealed that patients in Group A had low early morbidity (8.8 percent), no mortality, and no reoperations due to recurrent choledocholithiasis. In contrast, in Group B patients there was a mortality of 4.4 percent, an early morbidity of 26.6 percent, and a late recurrence and reoperation rate of 20.9 percent. The difference in those elements between patients in Group A and Group B is considered significant (p less than 0.05, p less than 0.001, and p less than 0.0001, mortality and early and late morbidity, respectively). It is recommended that at least for a proportion of patients with recurrent choledocholithiasis who present with clinical and operative findings similar to those in this study, choledochoduodenostomy has to be considered the method of choice.
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation; D012008:Recurrence; D012086:Reoperation