Choledochoduodenostomy versus hepaticojejunostomy – a matched case–control analysis
| Autor: | Lotte C. Franken, Susan van Dieren, Thomas M. van Gulik, Marc G. Besselink, Olivier R. Busch, A. Marthe Schreuder |
|---|---|
| Přispěvatelé: | Graduate School, Surgery, APH - Methodology, Amsterdam Gastroenterology Endocrinology Metabolism |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Sump Syndrome 030230 surgery Anastomosis 03 medical and health sciences Postoperative Complications 0302 clinical medicine Acute cholecystitis medicine Humans In patient Retrospective Studies Reflux gastritis Hepatology business.industry Anastomosis Surgical Gastroenterology Anastomosis Roux-en-Y medicine.disease Surgery Treatment Outcome Case-Control Studies Choledochostomy 030220 oncology & carcinogenesis Case control analysis Pancreatitis business Abdominal surgery |
| Zdroj: | HPB: The official journal of the International Hepato Pancreato Biliary Association, 23(4), 560-565. John Wiley and Sons Inc. |
| ISSN: | 1365-182X |
| Popis: | Background Choledochoduodenostomy (CD) is believed to cause certain long-term complications, such as sump syndrome and reflux gastritis. Therefore, CD is considered inferior to a Roux-and-Y hepaticojejunostomy (HJ). The aim of this study was to compare short- and long-term outcomes following CD and HJ for benign biliary diseases. Methods This was a retrospective, matched case-control study of patients undergoing biliary-digestive anastomosis for benign diseases between 2000 and 2016 in a tertiary centre. Patients undergoing CD and HJ were matched 1:1 based on age, sex, ASA-classification, indication, history of abdominal surgery or acute cholecystitis/pancreatitis. Short- and long-term outcomes were compared. Results Of 336 patients undergoing biliary-digestive anastomoses, 27 patients underwent CD. Matching resulted in two comparable groups of 26 patients each. Overall morbidity after HJ and CD was comparable: 30.8% versus 26.9% (p>0.999). Long-term complications occurred in 23.1% after HJ, and in 50% after CD (p=0.118). After CD, 2 patients (7.7%) developed sump syndrome. Both patients with an anastomotic stricture after HJ could be managed by endoscopic/radiological re-intervention, whilst all six patients with a stricture after CD required surgical re-intervention (p=0.016). Conclusion Although short-term complications were comparable, the number of anastomotic strictures was higher in patients undergoing CD. We therefore conclude that HJ is the biliary bypass of choice while CD should be performed in selected patients only. |
| Databáze: | OpenAIRE |
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