Role of Bilioenteric Bypass in the Management of Biliary Stone Disease

  • Lucio Lucas Pereira
  • Horacio J. AsbunEmail author


In this chapter we describe the surgical technique for the management of primary stones of the extrahepatic biliary tree, commonly in patients who have undergone cholecystectomy and multiple ERCP procedures to evacuate recurrent common bile duct stones. Surgical procedures are preferable as a definitive treatment in these patients to allow for symptom resolution, avoid the risk of recurrent pancreatitis and cholangitis as well as the need for repeated endoscopic retrograde cholangiopancreatography (ERCP) procedures.


Biliary Anastomoses Bilioenteric Hepatic duct Choledochoduodenostomy Hepaticojejunostomy 

Supplementary material

Video 11.1

Choledocotomy and stone extraction (Modified with permission from Asbun HJ, Stauffer J. Ch 11. Laparoscopic Bile Duct Resection and Hepaticojejunostomy for Type I Choledochal Cyst. In: Asbun HJ, Geller DA (eds). ACS Multimedia Atlas of Surgery: Liver Surgery Volume. Woodbury, CT: Ciné-Med. 2014) (MP4 34613 kb)

Video 11.2

Choledochoduodenostomy anastomoses (Modified with permission from Asbun HJ, Stauffer J. Ch 11. Laparoscopic Bile Duct Resection and Hepaticojejunostomy for Type I Choledochal Cyst. In: Asbun HJ, Geller DA (eds). ACS Multimedia Atlas of Surgery: Liver Surgery Volume. Woodbury, CT: Ciné-Med. 2014) (MP4 80517 kb)


  1. 1.
    Gallstones and laparoscopic cholecystectomy. NIH consensus statement. 1992;10(3):1–20.Google Scholar
  2. 2.
    Leung JW, Liu YL, Leung PS, Chan RC, Inciardi JF, Cheng AF. Expression of bacterial β-glucuronidase in human bile: an in vitro study. Gastrointest Endosc. 2001;54(3):346–50.CrossRefGoogle Scholar
  3. 3.
    Scientific Committee of the European Association for Endoscopic Surgery (EAES). Diagnosis and treatment of common bile duct stones (CBDS). Results of a consensus development conference. Surg Endosc. 1998;12:856–64.CrossRefGoogle Scholar
  4. 4.
    Hungness ES, Soper NJ. Management of common bile duct stones. J Gastrointest Surg. 2006;10:612–9.CrossRefGoogle Scholar
  5. 5.
    Yang MH, Chen TH, Wang SE, Tsai YF, Su CH, Wu CW, et al. Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2008;22:1620–4.CrossRefGoogle Scholar
  6. 6.
    American Society for Gastrointestinal Endoscopy (A.S.G.E) Standards of Practice Committee. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010;71:1–9.CrossRefGoogle Scholar
  7. 7.
    Narayanan SK, Chen Y, Narasimhan KL, Cohen RC. Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: a systematic review and meta-analysis. J Pediatr Surg. 2013;48(11):2336–42.CrossRefGoogle Scholar
  8. 8.
    Luu C, Lee B, Stabile BE. Choledochoduodenostomy as the biliary-enteric bypass of choice for benign and malignant distal common bile duct strictures. Am Surg. 2013;79(10):1054–7.PubMedGoogle Scholar
  9. 9.
    Farrar T, Painter MW, Betz R. Choledochoduodenostomy. In the treatment of stenosis in the distal common duct. Arch Surg. 1969;98(4):442–6.CrossRefGoogle Scholar
  10. 10.
    DuCoin C, Moon RC, Teixeira AF, Jawad MA. Laparoscopic choledochoduodenostomy as an alternate treatment for common bile duct stones after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2014;10(4):647–52.CrossRefGoogle Scholar
  11. 11.
    Overby DW, Richardson W, Fanelli R. Choledocholithiasis after gastric bypass: a growing problem. Surg Obes Relat Dis. 2014;10(4):652–3.CrossRefGoogle Scholar
  12. 12.
    Chander J, Mangla V, Vindal A, Lal P, Ramteke VK. Laparoscopic choledochoduodenostomy for biliary stone disease: a single-center 10-year experience. J Laparoendosc Adv Surg Tech A. 2012;22(1):81–4.CrossRefGoogle Scholar
  13. 13.
    El Nakeeb A, Askr W, El Hanafy E, Atef E, Hamdy E, El Hemaly M, et al. Long term outcomes of choledochoduodenostomy for common bile duct stones in the era of laparoscopy and endoscopy. Hepato-Gastroenterology. 2015;62(137):6–10.PubMedGoogle Scholar
  14. 14.
    Priego P, Escrig J, Ángel V, Villegas C, Salvador JL. Laparoscopic choledochoduodenostomy: an option in cases of obstructive biliary tract. Am Surg. 2015;81(5):E195–7.PubMedGoogle Scholar
  15. 15.
    Lechaux J-P, Lechaux D. Anastomoses biliodigestives dans la lithiase biliaire. EMC - Techniques chirurgicales - Appareil digestif. 2007;2:1–9.Google Scholar
  16. 16.
    Malik AA, Rather SA, Bari SU, Wani KA. Long-term results of choledochoduodenostomy in benign biliary obstruction. World J Gastrointest Surg. 2012;4(2):36–40.CrossRefGoogle Scholar
  17. 17.
    Matsushima K, Soybel DI. Operative management of recurrent choledocholithiasis. J Gastrointest Surg. 2012;16(12):2312–7.CrossRefGoogle Scholar
  18. 18.
    Jabłońska B, Lampe P. Reconstructive biliary surgery in the treatment of iatrogenic bile duct injuries. J Gastrointest Surg. 2009;13(6):1084–93.CrossRefGoogle Scholar
  19. 19.
    Kadaba RS, Bowers KA, Khorsandi S, Hutchins RR, Abraham AT, Sarker SJ, et al. Complications of biliary-enteric anastomoses. Ann R Coll Surg Engl. 2016;23:1–6.Google Scholar
  20. 20.
    Goessmann H, Lang SA, Fichtner-Feigl S, Scherer MN, Schlitt HJ, Stroszczynski C, et al. Biliodigestive anastomosis: indications, complications and interdisciplinary management. Chirurg. 2012;83(12):1097–108.CrossRefGoogle Scholar
  21. 21.
    Felder SI, Menon VG, Nissen NN, Margulies DR, Lo S, Colquhoun SD. Hepaticojejunostomy using short-limb Roux-en-Y reconstruction. JAMA Surg. 2013;148(3):253–7. discussion 257–8.CrossRefGoogle Scholar
  22. 22.
    Râmboiu S, Ghiţă F, Nicoli RE, Georgescu I. The role of biliodigestive derivations in the treatment of choledocholithiasis. Curr Health Sci J. 2011;37(4):181–4.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General SurgeryMayo Clinic FloridaJacksonvilleUSA
  2. 2.Department of SurgeryMayo Clinic FloridaJacksonvilleUSA

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