Long-term results of choledochoduodenostomy in benign biliary obstruction

Table 1 Final diagnosis in patients¹ (n = 270)

No.	Presentation	Male		Female		Total
		n	% age	n	% age	n	% age
1	Calculus group	41	15.18	92	34.07	133	49.26
2	OCH group	39	14.44	42	15.55	81	30.00
3	B.B. Strictures/ligatures2	9	03.33	17	06.29	26	09.63
4	Others	10	03.70	20	07.40	30	11.11
	Total	99	36.66	171	63.33	270	100

¹More findings than one were present in many cases;

²This group also includes cases of ampullary stenosis.

Table 2 Post-operative complications in cases (n = 270) (%)

Complications	Calculusgroup	OCH group	Stricture group	Others group	Total	P value
Wound
Infection	9 (6.76)	6 (7.4)	1 (3.84)	1 (3.33)	17 (6.2)	> 0.05
Dehiscence	-	-	-	1 (3.33)	1 (0.3)	> 0.05
Hernia	1 (0.7)	-	-	-	-	> 0.05
Post-op. fever	5 (3)	10 (12)	1 (3)	1 (3)	17 (6)	> 0.05
Septicaemia	-	4 (5)	1 (3)	2 (6)	7 (3)	> 0.05
Pulmonary
Atelectasia	6 (4)	3 (3)	2 (7)	1 (3)	12 (4)	> 0.05
Pneumonia	1 (0.75)	2 (2)	-	-	3 (1)	> 0.05
Peritoneal
Haemorrhage	-	-	-	-	-
Bile drainage	1 (0.75)	2 (2)	1 (3)	-	4 (2)	> 0.05
Cardiovascular	-	-	-	-	-
MI	-	-	-	-	-
Arrhythmia	-	2 (2)	-	-	2 (0.74)	> 0.05
Total					63 (23.3)	NS

P value > 0.05 (non-significant). NS: Non-significant; OCH: Oriental cholangiohepatitis; MI: Myocardial infarction.

Table 3 Incidence of long-term complications (n = 225) (%)

Complications	CalculusGroup n = 106	OCH group n = 81	Stricture group n = 22	Others group n = 16	Total	P value
Alkaline gastritis	6 (5.67)	4 (5.4)	1 (4.5)	-	11 (4.88)	> 0.05
Cholangitis	-	5 (6.8)	1 (4.5)	1 (3.84)	7 (3)	> 0.05
Liver abscess	-	3 (3.7)	-	-	3 (1)	> 0.05
Stenosis of anastomosis	1 (0.96)	-	1 (4.5)	-	2 (0.8)	> 0.05

P value > 0.05 (non-significant). OCH: Oriental cholangiohepatitis.

Table 4 Clinical classification of the patients (n = 225)

Results	Patient complaint	Ultrasonography	Liver function test	EGD	HIDA scan	Total
Excellent	None	Normal	Normal	-	-	116 (51.55%)
Good	Occasionally dyspeptic	Normal	Normal	+/-	-	93 (41.33%)
Moderate	Evident dyspepsia, nausea, bilious vomiting or fever rigours	Normal or IHD dilated	Normal or slightly deranged	Alkaline gastritis	Patent anastomosis evidence of gastric reflux	11 (4.88%)
Bad	Septecemia/cholangitis, anastomotic stenosis	Liver abscesses	Grossly deranged	+/-	Patent anastomosis, dilated IHD with slow transit	5 (2.22%)

EGD: Esophagogastroduodenoscopy; IHD: Intra-hepatic duct.

Table 5 Demographics, diagnosis and cause of death of 7 patients who died after choledochoduodenostomy

No.	Age ( yr)	Sex	Time	Initial daignosis	Cause of death
1	55	M	1st POD	Suppurative cholangitis	Septic shock/DIC
2	32	F	2nd POD	Biliary peritonitis	Septicaemia with arrhythmia
3	65	M	12th POD	Infected liver hydatid with intra-biliary rupture	Wound dehiscence with septicaemia with ARDS
4	54	M	8 mo	OCH with right lobe liver abscess with cholangitis	Septicaemia with MODS
5	46	F	13 mo	OCH with multiple liver abscess	Septicaemia with MODS
6	58	F	15 mo	Suppurative cholangitis	Arrhythmia
7	45	M	10 yr	OCH with multiple liver abscess with sepsis	Septicaemia with MODS

OCH: Oriental cholangiohepatitis; MODS: Multiple organ dysfunction syndrome; DIC: Disseminated intravascular coagulation; ARDS: Acute respiratory distress syndrome.