Journal of Gastrointestinal Surgery

, Volume 16, Issue 12, pp 2312–2317 | Cite as

Operative Management of Recurrent Choledocholithiasis

  • Kazuhide Matsushima
  • David I. Soybel



With the advent of endoscopic and image-directed percutaneous approaches, it is increasingly uncommon to require a surgical approach for recurrent bile duct stones.


We describe open side-to-side choledochoduodenostomy as one of the surgical options for recurrent bile duct stones. This procedure includes the following elements: exposure of the common bile duct, mobilization of the duodenum (Kocher maneuver), choledochotomy, inspection of the bile duct with a choledochoscopy, and anastomosis of the bile duct with the duodenum. Other options for operative management are discussed.


Surgical drainage procedures for recurrent bile duct stones can be performed for patients who fail to respond to endoscopic and nonoperative interventional treatments with good long-term outcomes.


Recurrent bile duct stone Operative management Biliary drainage 


Conflict of interest



  1. 1.
    Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg. 2004;239:28–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Uchiyama K, Onishi H, Tani M, Kinoshita H, Kawai M, Ueno M, Yamaue H. Long-term prognosis after treatment of patients with choledocholithiasis. Ann Surg. 2003;238:97–102.PubMedGoogle Scholar
  3. 3.
    Way LW, Admirand WH, Dunphy JE. Management of choledocholithiasis. Ann Surg. 1972;176:347–359.PubMedCrossRefGoogle Scholar
  4. 4.
    Vogt DP, Hermann RE. Choledochoduodenostomy, choledochojejunostomy or sphincteroplasty for biliary and pancreatic disease. Ann Surg. 1981;193:161–168.PubMedCrossRefGoogle Scholar
  5. 5.
    Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335:909–918.PubMedCrossRefGoogle Scholar
  6. 6.
    Ray AA, Davies ET, Duvdevani M, Razvi H, Denstedt JD. The management of treatment-resistant biliary calculi using percutaneous endourologic techniques. Can J Surg. 2009;52:407–412.PubMedGoogle Scholar
  7. 7.
    Baron TH, Harewood GC. Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials. Am J Gastroenterol. 2004;99:1455–1460.PubMedCrossRefGoogle Scholar
  8. 8.
    Kohn GP, Hassen AS, Banting SW, Mackay S, Cade RJ. Endoscopic management of recurrent primary bile duct stones. ANZ J Surg. 2008;78:579–582.PubMedCrossRefGoogle Scholar
  9. 9.
    Lopes TL, Wilcox CM. Endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anatomy. Gastroenterol Clin North Am. 2010;39:99–107.PubMedCrossRefGoogle Scholar
  10. 10.
    Itoi T, Ishii K, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Tsuji S, Ikeuchi N, Umeda J, Moriyasu F. Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis (with video). Am J Gastroenterol. 2010;105:93–99.PubMedCrossRefGoogle Scholar
  11. 11.
    Cha SW, Park MS, Kim KW, Byun JH, Yu JS, Kim MJ, Kim KW. Choledochal cyst and anomalous pancreaticobiliary ductal union in adults: radiological spectrum and complications. J Comput Assist Tomogr. 2008;32:17–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Sanders RL. Indications for and Value of Choledochoduodenostomy. Ann Surg. 1946;123:847–855.CrossRefGoogle Scholar
  13. 13.
    Rhodes M, Nathanson L. Laparoscopic choledochoduodenostomy. Surg Laparosc Endosc. 1996;6:318–321.PubMedCrossRefGoogle Scholar
  14. 14.
    Rattner DW, Warshaw AL. Impact of choledochoscopy on the management of choledocholithiasis. Experience with 499 common duct explorations at the Massachusetts General Hospital. Ann Surg. 1981;194:76–79.PubMedCrossRefGoogle Scholar
  15. 15.
    Topal B, Aerts R, Penninckx F. Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Surg Endosc. 2007;21:2317–2321.PubMedCrossRefGoogle Scholar
  16. 16.
    Jeyapalan M, Almeida JA, Michaelson RL, Franklin ME Jr. Laparoscopic choledochoduodenostomy: review of a 4-year experience with an uncommon problem. Surg Laparosc Endosc Percutan Tech. 2002;12:148–153.PubMedCrossRefGoogle Scholar
  17. 17.
    Antibiotic prophylaxis for surgery. Treatment guidelines. The Medical Letter. 2009;7:47–52.Google Scholar
  18. 18.
    Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM; American College of Chest Physicians. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e227S-77S.PubMedCrossRefGoogle Scholar
  19. 19.
    Cameron JL. Retained and recurrent bile duct stones: operative management. Am J Surg. 1989;158:218–221.PubMedCrossRefGoogle Scholar
  20. 20.
    Saharia PC, Zuidema GD, Cameron JL. Primary common duct stones. Ann Surg. 1977;185:598–604.PubMedCrossRefGoogle Scholar
  21. 21.
    Colcock BP, Liddle HV. Common bile-duct stones. N Engl J Med. 1958;258:264–268.PubMedCrossRefGoogle Scholar
  22. 22.
    Madden JL. Common duct stones. Their origin and surgical management. Surg Clin North Am. 1973;53:1095–1113.PubMedGoogle Scholar
  23. 23.
    Thistle JL. Pathophysiology of bile duct stones. World J Surg. 1998;22:1114–1118.PubMedCrossRefGoogle Scholar
  24. 24.
    Kim MH, Sekijima J, Lee SP. Primary intrahepatic stones. Am J Gastroenterol. 1995;90:540–548.PubMedGoogle Scholar
  25. 25.
    Panis Y, Fagniez PL, Brisset D, Lacaine F, Levard H, Hay JM. Long term results of choledochoduodenostomy versus choledochojejunostomy for choledocholithiasis. The French Association for Surgical Research. Surg Gynecol Obstet. 1993;177:33–37.PubMedGoogle Scholar
  26. 26.
    Jones SA. Sphincteroplasty (not sphincterotomy) in the treatment of biliary tract disease. Surg Clin North Am. 1973;53:1123–1137.PubMedGoogle Scholar
  27. 27.
    Miccini M, Amore Bonapasta S, Gregori M, Bononi M, Fornasari V, Tocchi A. Indications and results for transduodenal sphincteroplasty in the era of endoscopic sphincterotomy. Am J Surg. 2010;200:247–251.PubMedCrossRefGoogle Scholar
  28. 28.
    Lauter DM, Froines EJ. Laparoscopic common duct exploration in the management of choledocholithiasis. Am J Surg. 2000;179:372–374.PubMedCrossRefGoogle Scholar
  29. 29.
    Nguyen KT, Zureikat AH, Chalikonda S, Bartlett DL, Moser AJ, Zeh HJ. Technical aspects of robotic-assisted pancreaticoduodenectomy (RAPD). J Gastrointest Surg. 2011;15:870–875.PubMedCrossRefGoogle Scholar
  30. 30.
    Jayaraman S, Gonen M, Brennan MF, D’Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Allen PJ. Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J Am Coll Surg. 2010;211:503–509.PubMedCrossRefGoogle Scholar
  31. 31.
    Khajanchee YS, Cassera MA, Hammill CW, Swanström LL, Hansen PD. Outcomes following laparoscopic choledochoduodenostomy in the management of benign biliary obstruction. J Gastrointest Surg. 2012;16:801–805.PubMedCrossRefGoogle Scholar
  32. 32.
    Tang CN, Siu WT, Ha JP, Li MK. Laparoscopic choledochoduodenostomy: an effective drainage procedure for recurrent pyogenic cholangitis. Surg Endosc. 2003;17:1590–1594.PubMedCrossRefGoogle Scholar
  33. 33.
    Tian Y, Wu SD, Zhu AD, Chen DX. Management of type I choledochal cyst in adult: totally laparoscopic resection and Roux-en-Y hepaticoenterostomy. J Gastrointest Surg. 2010;14:1381–1388.PubMedCrossRefGoogle Scholar
  34. 34.
    Parrilla P, Ramirez P, Sanchez Bueno F, Perez JM, Candel MF, Muelas MS, Robles R. Long-term results of choledochoduodenostomy in the treatment of choledocholithiasis: assessment of 225 cases. Br J Surg. 1991 Apr;78(4):470–2.PubMedCrossRefGoogle Scholar
  35. 35.
    Leppard WM, Shary TM, Adams DB, Morgan KA. Choledochoduodenostomy: is it really so bad? J Gastrointest Surg. 2011;15:754–757.PubMedCrossRefGoogle Scholar
  36. 36.
    Malik AA, Rather SA, Bari SU, Wani KA. Long-term results of choledochoduodenostomy in benign biliary obstruction. World J Gastrointest Surg. 2012;4:36–40.PubMedCrossRefGoogle Scholar
  37. 37.
    Mavrogiannis C, Liatsos C, Romanos A, Goulas S, Dourakis S, Nakos A, Karvountzis G. Sump syndrome: endoscopic treatment and late recurrence. Am J Gastroenterol. 1999;94:972–975.PubMedCrossRefGoogle Scholar
  38. 38.
    de Almeida AM, Cruz AG, Aldeia FJ. Side-to-side choledochoduodenostomy in the management of choledocholithiasis and associated disease. Facts and fiction. Am J Surg. 1984;147:253–259.PubMedCrossRefGoogle Scholar
  39. 39.
    Johnson AG, Stevens AE. Importance of the size of the stoma in choledocho-duodenostomy. Gut. 1969;10:68–70.PubMedCrossRefGoogle Scholar
  40. 40.
    Caroli-Bosc FX, Demarquay JF, Peten EP, Dumas R, Bourgeon A, Rampal P, Delmont JP. Endoscopic management of sump syndrome after choledochoduodenostomy: retrospective analysis of 30 cases. Gastrointest Endosc. 2000;51:180–183.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  1. 1.Department of SurgeryPenn State Milton S. Hershey Medical CenterHersheyUSA
  2. 2.HersheyUSA

Personalised recommendations