title: Open Choldecho-Enterostomy for Common Bile Duct Stones: Is it Out of Date in Laparo-Endoscopic Era?
abstract: BACKGROUND
  Nowadays, biliary-enteric drainage (BED) is regarded as a last resort or obsolete therapeutic method for common bile duct stone (CBDS) not only because of advances in minimally invasive therapeutic modalities but also due to fears of higher morbidity, cholangitis, and "sump" syndrome.
  
  
  OBJECTIVE
  The present study aimed at evaluating the outcome of this procedure for choledocholithiasis.
  
  
  METHODS
  It is a retrospective review of 51 patients who underwent open choledochoenterostomy for CBDS between January 2005 and December 2009.
  
  
  RESULTS
  About 40 women (78%) and 11 men underwent open BED (mean age 72 years). Indications were elderly patients (90%), multiple stones (54.9%) and unextractable calculi (15.4%). We performed 49 (96%) side to side choledochoduodenostomies, one end to side choledochoduodenostomy (CDS) and one end to side hepaticojejunostomy. The mortality rate was 3.9%. Overall morbidity was 12% with no biliary leakage. With a decline of 1-6 years, neither sump syndrome nor cholangiocarcinoma occurred.
  
  
  CONCLUSIONS
  Side-to-side CDS is a safe and highly effective therapeutic measure, even when performed on ducts less than 15 mm wide, provided a few technical requirements are respected. Patients experiencing relapsing cholangitis after BED should be closely monitored for the late development of biliary tract malignancies.
authors.affiliation: Department of General Surgery, Professor Rached Letaief at Farhat Hached Hospital, Sousse, Tunisia.
authors.forename: Khnissi
authors.initials: K
authors.lastname: Abdelmajid
authors.forename: Harbi
authors.initials: H
authors.lastname: Houssem
authors.forename: Ghrissi
authors.initials: G
authors.lastname: Rafik
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Jarrar
authors.forename: Hamila
authors.initials: H
authors.lastname: Fehmi
keywords: Cholangiocarcinoma; Cholangitis; Choledochoduodenostomy; Sump syndrome