title: Choledochoduodenostomy: is it really so bad?
abstract: BACKGROUND
  Choledochoduodenostomy (CDD) has been shunned by some surgeons for the management of the benign distal common bile duct stricture due to the potential complication of "sump syndrome." The feared sump syndrome is theorized to occur from bile stasis and reflux of duodenal contents into the terminal common bile duct with bacterial overgrowth, resulting in cholangitis or hepatic abscess. The true incidence and resultant morbidity of sump syndrome, however, are not well defined.
  
  
  METHODS
  With the approval of the Institutional Review Board, a retrospective chart review of all patients undergoing choledochoduodenostomy for benign disease at a single institution between 1994 and 2008 was undertaken. Data were collected with particular attention to operative indications, perioperative course, and long-term results. Long-term outcomes were assessed through clinical reports at outpatient follow-up, emergency room visits, and hospital readmissions.
  
  
  RESULTS
  Seventy-nine patients underwent side-to-side CDD for benign diseases over the 15-year period [51 (65%) men; mean age, 52 years (standard deviation (SD), 12)]. Indications for surgery included chronic pancreatitis (80%), choledocholithiasis (11%), and cholangitis (4%). Patients presented with abdominal pain (80%), nausea/vomiting (30%), and jaundice 13%. Sixty-one patients (77%) underwent an additional procedure at the time of their CDD, including lateral pancreaticojejunostomy (26%). There was no perioperative mortality. Postoperative complications occurred in 15 (19%) patients, including intraabdominal abscess (26%), wound infection (20%), and biliary leakage (13%). The mean hospital stay was 9.7 days (SD, 6.9). The mean follow-up was 6.2 years (SD, 4.2). There was no occurrence of cholangitis. Two patients (2.5%) developed hepatic abscess, which was managed by antibiotics and image-guided percutaneous drainage.
  
  
  CONCLUSIONS
  CDD is a safe and effective method of decompressing the distal common bile duct in benign pancreatobiliary disease. Long-term results are acceptable, with sump syndrome being a rare occurrence.
authors.affiliation: Medical University of South Carolina, 96 Jonathan Lucas Street, 420 Clinical Science Building, Charleston, SC 29425, USA. leppard@musc.edu
authors.forename: William McIver
authors.initials: WM
authors.lastname: Leppard
authors.forename: Thomas Michael
authors.initials: TM
authors.lastname: Shary
authors.forename: David B
authors.initials: DB
authors.lastname: Adams
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Morgan
mesh_terms: D002768:Choledochostomy / Q000379:methods*; D001651:Cholestasis, Extrahepatic / Q000601:surgery*; D003135:Common Bile Duct; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome