Reoperations after choledochoduodenostomy: a new approach.

Reoperation after choledochoduodenostomy was performed in seven cases. Stenosis of the anastomosis, bile duct stones, cholangitis and stump syndrome were found in five cases. In the first two cases, disconnection of the choledochoduodenostomy and sphincteroplasty were performed: one patient died of duodenal leakage. In the third case, retrograde sphincteroplasty was performed with lethal failure. In the following four cases, a new approach which consisted of antropyloroduodenotomy, catheter guided sphincteroplasty, extraction of stones and debris, and reconstruction with a Finney gastroduodenostomy was used. Endoluminal suture of previous choledochoduodenostomy was also performed in three cases and vagotomy in two. This approach resulted in no mortality and the results were excellent in all cases. The patients were followed up for from nine months to three and a half years. The authors found this endoluminal approach an easier and safer surgical procedure.