Surgical approaches to recurrent choledocholithiasis. Choledochoduodenostomy versus T-tube drainage after choledochotomy

Abstract

To assess the value of choledochoduodenostomy versus T-tube drainage to manage patients with recurrent choledocholithiasis, a prospective, randomized study was carried out where under strict criteria of selection, 45 patients underwent choledochoduodenostomy after choledochotomy (Group A), and another 45 patients underwent T-tube drainage (Group B). Results revealed that patients in Group A had low early morbidity (8.8 percent), no mortality, and no reoperations due to recurrent choledocholithiasis. In contrast, in Group B patients there was a mortality of 4.4 percent, an early morbidity of 26.6 percent, and a late recurrence and reoperation rate of 20.9 percent. The difference in those elements between patients in Group A and Group B is considered significant (p less than 0.05, p less than 0.001, and p less than 0.0001, mortality and early and late morbidity, respectively). It is recommended that at least for a proportion of patients with recurrent choledocholithiasis who present with clinical and operative findings similar to those in this study, choledochoduodenostomy has to be considered the method of choice.