title: Choledochoduodenostomy re-evaluated in the endoscopic and laparoscopic era.
abstract: OBJECTIVE
  One of the options for draining an obstructed biliary tree is to form a choledochoduodenostomy (CDD). We evaluate our experience with this procedure with regard to complications (immediate and late), long term patency and patient survival.
  
  
  METHODS
  An analysis was performed on a prospectively maintained database of all patients undergoing CDD under a single surgeon from 1992-2009. Data included pre-operative status, indications for surgery, postoperative morbidity and mortality, and complications.
  
  
  RESULTS
  Sixty-eight CDDs were performed (40 male, 28 female). Thirty-seven (54%) were performed for benign disease (group A) and 31 (46%) for malignant disease (histologically confirmed, group B). Patients in group B were older (58 years vs. 69 years, p=0.009), and had higher preoperative bilirubin (58 vs. 156mg/dL, p=0.0003) and alkaline phosphatase (434 vs. 696 U/L, p=0.01). In hospital mortality was 7.5% in group A, and 9% in group B. Patients in group A had a shorter postoperative stay (p=0.008). Long-term mortality was significantly greater in group B (p<0.0001). Long term complications were lower in group A (14%) vs. group B (16%). In group B recurrent jaundice occurred in 3 patients (9.7%), of which 2 were successfully stented at ERCP, and one patient developed ascending cholangitis.
  
  
  CONCLUSIONS
  CDD remains a relatively safe and effective surgical option for the treatment of obstructive jaundice in both benign and malignant disease. It remains a very useful tool where ERCP has failed, in patients with unresectable pancreatic malignancies, and in patients with recurrent choledocholithiasis.
authors.affiliation: Department of Surgery, Royal Glamorgan Hospital, Wales, UK.
authors.forename: David C
authors.initials: DC
authors.lastname: Bosanquet
authors.forename: Martin
authors.initials: M
authors.lastname: Cole
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Conway
authors.forename: Michael H
authors.initials: MH
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002768:Choledochostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004724:Endoscopy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016526:Workload