Highlights
- •Choledochoduodenostomy demonstrates outcomes comparable to choledochojejunostomy.
- •Higher odds of cholangitis with choledochojejunostomy versus choledochoduodenostomy.
- •Choledochoduodenostomy provides easier post-operative endoscopic access.
- •Choledochoduodenostomy continues to be a safe alternative to choledochojejunostomy.
Abstract
Debate continues as to whether choledochoduodenostomy (CDD) can be used instead of
Roux-en-Y choledochojejunostomy (CDJ) when duct-to-duct (DTD) is not an option. We
hypothesized that CDD and CDJ had similar rates of complications. All deceased-donor
liver transplantations from September 2011 to March 2020 were categorized by biliary
reconstruction. Primary outcomes were bleeding, bile leak, anastomotic stricture,
and cholangitis. Of the 1,086 patients, 812 (74.8%) received a DTD; 225 (20.7%) received
a CDD; and 49 (4.5%) received a CDJ. Cholangitis was significantly higher in CDJ compared
to DTD and CDD (26.5% vs 6% vs 13.8%, p < 0.0001). When controlling for significant
confounders, CDJ had 10.2 higher odds of cholangitis (95% CI 4.4–23.2) compared to
DTD, and 3.3 higher odds compared to CDD (95% CI 1.4–7.8). When compared to DTD, CDJ
and CDD had significantly lower odds of stricture. CDD continues to be a safe alternative
for biliary reconstruction in deceased-donor liver transplantation.
Keywords
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Article info
Publication history
Published online: October 16, 2022
Accepted:
October 13,
2022
Received in revised form:
September 25,
2022
Received:
March 25,
2022
Identification
Copyright
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