title: Outcomes following laparoscopic choledochoduodenostomy in the management of benign biliary obstruction.
abstract: BACKGROUND
  With the advent of endoscopic retrograde choledochoduodenostomy, the need for choledochoduodenostomy to treat common bile duct obstruction is less common, but occasionally required.
  
  
  METHODS
  Patients considered for laparoscopic choledochoduodenostomy secondary to benign conditions between 1999 and 2009 at a single institution were included. Charts were retrospectively reviewed for preoperative, operative, and long-term outcomes data.
  
  
  RESULTS
  Twenty patients were identified; 15 with chronic choledocholithiasis causing benign biliary obstruction or chronic recurrent cholangitis, 3 with chronic relapsing pancreatitis, and 2 with distal common bile duct strictures. Mean operative time was 270 min. No major operative complications were reported. Five patients with severe adhesions or portal hypertension required conversion to laparotomy. Median hospital stay was 6 days (range, 2-32). Postoperatively, three (20%) patients completed laparoscopically and three (66.7%) patients converted to laparotomy had complications. In addition, one death due to myocardial infarction was reported 4 weeks after hospital discharge. With an average follow-up of 21 months, only one patient (5%) developed recurrent symptoms.
  
  
  CONCLUSIONS
  Laparoscopic choledochoduodenostomy is a useful technique in patients with benign, refractory common bile duct obstruction. This technically demanding procedure is feasible; however, the associated comorbidities in this complex group of patients result in a relatively high complication rate.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Yashodhan S
authors.initials: YS
authors.lastname: Khajanchee
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.forename: Chet W
authors.initials: CW
authors.lastname: Hammill
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanström
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000473:pathology; D042883:Choledocholithiasis / Q000150:complications; D002768:Choledochostomy / Q000009:adverse effects; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome