Laparoscopic choledochoduodenostomy for management of benign distal biliary stricture: A single-center case series analysis

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Abstract

Purpose
The aim of this study was to assess the feasibility and safety of laparoscopic choledochoduodenostomy (LCDD) in the management of benign distal biliary stricture (BDBS).
Patients and methods
During a period of 3 years, this prospective study included 30 patients with BDBS and dilated common bile duct (CBD), after failure of endoscopic therapy. Patients were fully assessed (clinically, laboratory, and radiologically) to confirm the diagnosis and exclude malignancy. Surgery was performed 4–6 weeks after the last endoscopic maneuver. After CBD clearance, LCDD was done. Follow-up visits were scheduled at 1, 3, and 6 months, and annually thereafter.
Results
A total of 30 patients met our inclusion criteria. A total of 19 patients were women, with a mean±SD age of 47.4 ± 13.2 years. Overall, 40% of them had previous cholecystectomy. Intraoperatively five cases were excluded, as the choledochoscopy proved no distal stricture. The mean±SD operative time was 200.52 ± 62.17 min with a mean±SD blood loss of 111.6 ± 52.1 ml and one conversion. The mean±SD hospital stay was 5.8 ± 1.62 days, and the mean±SD follow-up period was 22.54 ± 8.11 months. Postoperative morbidity was 20%. There was no stone recurrence, and the mean values of total and direct bilirubin showed significant improvement compared with the preoperative values (1.44 ± 0.75 vs. 2.5 ± 2.48, value=0.021, and 0.76 ± 0.58 vs. 1.83 ± 2.37, value=0.015, respectively).
Conclusion
LCDD for BDBS with or without CBD stones is feasible, safe, and effective. However, longer term follow-up and larger studies are advised.

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