Long-term outcomes of choledochoduodenostomy for choledocholithiasis: increased incidence of postoperative cholangitis after total or distal gastrectomy

被引:0
作者
Futagawa, Yasuro [1 ]
Yasuda, Jungo [1 ]
Shiozaki, Hironori [1 ]
Ikeda, Keiichi [2 ]
Onda, Shinji [3 ]
Okamoto, Tomoyoshi [1 ]
Ikegami, Toru [3 ]
机构
[1] Jikei Univ, Daisan Hosp, Dept Surg, 4-11-1 Izumi Honcho, Komae, Tokyo 2018601, Japan
[2] Jikei Univ, Daisan Hosp, Dept Endoscopy, 4-11-1 Izumi Honcho, Komae, Tokyo 2018601, Japan
[3] Jikei Univ, Sch Med, Dept Surg, 3-25-8 Nishi Shimbashi,Minato Ku, Tokyo 1058461, Japan
关键词
Choledochoduodenostomy; Choledocholithiasis; Long-term outcomes; Cholangitis; Gastrectomy; BILE-DUCT STONES; FOLLOW-UP; HEPATOBILIARY SCINTIGRAPHY; ENDOSCOPIC SPHINCTEROTOMY; BILIARY RECONSTRUCTION; ROUX-Y; MANAGEMENT; GUIDELINES;
D O I
10.1007/s00595-023-02740-7
中图分类号
R61 [外科手术学];
学科分类号
摘要
Purpose Choledochoduodenostomy (CDD) is performed to treat choledocholithiasis (CDL) cases where endoscopic stone removal is difficult. Recognizing CDD characteristics is important for CDL treatment planning.Methods A total of 116 patients, including 33 patients = 80 years old (29 with previous total gastrectomy, 19 with previous distal gastrectomy, 20 with built-up stones, 19 with periampullary diverticulum, 10 with confluence stones, 8 with repetitive recurrent stones, 4 with hard stones, 3 with endoscopic retrograde cholangiography [ERC] not available due to lack of cooperation, 2 with a history of pancreatitis post-ERC, and 2 in whom ERC could not be performed due to a disturbed anatomy) underwent CDD for CDL. Postoperative complications and long-term outcomes were evaluated.Results The in-hospital mortality rate was 0%. The morbidity (grade = IIIA according to the Clavien-Dindo classification) rates in the elderly (= 80 years old) and non-elderly (51-79 years old) patients were 3.0% (1/33) and 2.4% (2/83), respectively (p = 0.85). Long-term complications included cholangitis in eight (7%) patients, of which three cases were repetitive and seven had an operative history of total or distal gastrectomy. The incidence of postoperative cholangitis after total or distal gastrectomy was 15% (7/48), which was significantly higher than that involving other causes (1.5%, 1/68; p < 0.01). Two patients with cholangitis after total gastrectomy experienced early recurrence of lithiasis at 2 and 9 months after surgery.Conclusions CDD is safe, even in elderly patients. However, a history of total gastrectomy or distal gastrectomy may increase the incidence of postoperative cholangitis.
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页码:331 / 339
页数:9
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