Biliary Bypass with Laparoscopic Choledochoduodenostomy
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Laparoscopic choledochoduodenostomy (LCDD) is employed to treat many benign biliary diseases when endoscopic or percutaneous techniques are not feasible. We describe our technique for LCDD, which utilizes common bile duct transection and an end-to-side biliary-enteric anastomosis. This procedure includes the following elements: isolation and transection of the common bile duct, mobilization of the duodenum (Kocher maneuver), inspection of the common bile duct, and end-to-side biliary-enteric anastomosis. Key details and pitfalls are discussed. Over a 5-year period, LCDD was performed on 18 patients. Indications included intractable abdominal pain (10) and choledocholithiasis (8). The majority of patients, 83%, tolerated the operation well with no complications. There was one postoperative intra-abdominal abscess and two anastomotic strictures, one in the immediate postoperative period and the other 9 months after the operation. The median length of stay was 4 days (IQR 3.0–5.3), and there was minimal blood loss. Based on our experience, LCDD with transection and end-to-side biliary-enteric anastomosis is a safe and effective biliary bypass technique.
KeywordsBiliary bypass Choledochoduodenostomy Laparoscopy
The authors would like to acknowledge Barbara Sturonas-Brown and the Visual Media Department at Indiana University School of Medicine for assistance with creation of the figures that accompany this manuscript.
JKK—data collection, data analysis and interpretation, original manuscript and revisions, development of figures and images, final approval of manuscript for publications, and agrees to be responsible for all aspects of the work. DPM—data collection, data analysis and interpretation, revision of critically important content of the manuscript and figures, final approval of manuscript, and agrees to be accountable for all aspects of the work. LGK—conception and design of the work, revision of critically important content of the manuscript and final figures, final approval of manuscript, and agrees to be accountable for all aspects of the work. AN—conception and design of the work, revision of critically important content of the manuscript and figures, final approval of manuscript, and agrees to be accountable for all aspects of the work.
This work received financial support from the NIH grant R02DK096167 and the Lily Endowment, Inc.
Compliance with Ethical Standards
Human subjects research approval for this study was obtained from the institutional review board of the Indiana University School of Medicine and was carried out in compliance with the IU Standard Operating Procedures for Research Involving Human Subjects.
Conflict of Interest
The authors declare that they have no conflict of interest.
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