Laparoscopic Choledochoduodenostomy for Treatment of Benign Common Bile Duct Strictures

N.Y. Bayramov,, Taryel I Omarov, N.A. Zeynalov. Azerbaijan Medical University, Baku, Azerbaijan.

Objective: This article presents the results of laparoscopic choledocho-duodenostomy (CDD) applied to 25 patients with benign strictures of distal part of common bile duct (CBD) and its dilatation.

Material and methods: 23 patients had combination of distal stricture of CBD and stones in gallbladder and CBD (2 patients -in CBD, 12- in gallbladder, 9- both in CBD and gallbladder), 2 patients had acalculous postcholecystectomy stricture. Laparoscopic CDD was performed by 5 trocars. 4 trocars were placed in the standard points for cholecystectomy, the 5-th trocar was placed by the right pararectal line at the umbilicus level and used for traction of duodenum and continuous aspiration. 2 sm length CDD was applied side-to-side by 4/0 vikryl or PDS interrupted sutures. 1, 3, 6 and 12 months after the surgery patients underwent USG examination and liver function tests, 6-12 months later endoscopic investigation to evaluate the anastomosis.

Results: 23 patients underwent laparoscopic cholecystectomy and choledochoduodenostomy, 2 patients- choledochoduodenostomy only. The mean duration of operation was 127±36 min (90-205 min). There was no conversion. The mean hospital stay was 4.5 days (3- 9 days). There was no mortality. 2 patients developed an anastomotic leak. One of them underwent relaparoscopy and T- drainage, in another patient the biliary leakage ceased spontaneously. 6 – 12 months later 19 patients were examined by endoscopy. In 4 of them anastomosis was not visualized, 15 had working anastomosis 6-10 mm diameter. Thus, after 25 laparoscopic CDD executed due to benign pathologies complications were noted in 2 patients (8%), excellent and good outcome in 21 (84%) patients, poor in 3 (12%) and very poor in 1 (4%) patient.

Conclusion: Laparoscopic choledochoduodenostomy performed by experienced surgeons in selected patients provides good long-term results and could be the alternative to endoscopic sphincterotomy.

Key words: Laparoscopic choledochoduodenostomy Endoscopic sphincterotomy Benign strictures Common bile duct.

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