Journal of Gastrointestinal Surgery

, Volume 22, Issue 5, pp 928–933 | Cite as

Biliary Bypass with Laparoscopic Choledochoduodenostomy

  • Joshua K. KaysEmail author
  • Leonidas G. Koniaris
  • Daniel P. Milgrom
  • Attila Nakeeb
How I do it


Laparoscopic choledochoduodenostomy (LCDD) is employed to treat many benign biliary diseases when endoscopic or percutaneous techniques are not feasible. We describe our technique for LCDD, which utilizes common bile duct transection and an end-to-side biliary-enteric anastomosis. This procedure includes the following elements: isolation and transection of the common bile duct, mobilization of the duodenum (Kocher maneuver), inspection of the common bile duct, and end-to-side biliary-enteric anastomosis. Key details and pitfalls are discussed. Over a 5-year period, LCDD was performed on 18 patients. Indications included intractable abdominal pain (10) and choledocholithiasis (8). The majority of patients, 83%, tolerated the operation well with no complications. There was one postoperative intra-abdominal abscess and two anastomotic strictures, one in the immediate postoperative period and the other 9 months after the operation. The median length of stay was 4 days (IQR 3.0–5.3), and there was minimal blood loss. Based on our experience, LCDD with transection and end-to-side biliary-enteric anastomosis is a safe and effective biliary bypass technique.


Biliary bypass Choledochoduodenostomy Laparoscopy 



The authors would like to acknowledge Barbara Sturonas-Brown and the Visual Media Department at Indiana University School of Medicine for assistance with creation of the figures that accompany this manuscript.

Author Contributions

JKK—data collection, data analysis and interpretation, original manuscript and revisions, development of figures and images, final approval of manuscript for publications, and agrees to be responsible for all aspects of the work. DPM—data collection, data analysis and interpretation, revision of critically important content of the manuscript and figures, final approval of manuscript, and agrees to be accountable for all aspects of the work. LGK—conception and design of the work, revision of critically important content of the manuscript and final figures, final approval of manuscript, and agrees to be accountable for all aspects of the work. AN—conception and design of the work, revision of critically important content of the manuscript and figures, final approval of manuscript, and agrees to be accountable for all aspects of the work.

Funding Sources

This work received financial support from the NIH grant R02DK096167 and the Lily Endowment, Inc.

Compliance with Ethical Standards

Human subjects research approval for this study was obtained from the institutional review board of the Indiana University School of Medicine and was carried out in compliance with the IU Standard Operating Procedures for Research Involving Human Subjects.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material


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  1. 1.
    Leppard WM, Shary TM, Adams DB, Morgan KA. Choledochoduodenostomy: is it really so bad? J Gastrointest Surg. 2011;15:754–757.CrossRefPubMedGoogle Scholar
  2. 2.
    Khajanchee YS, Cassera MA, Hammill CW, Swanstrom LL, Hansen PD. Outcomes following laparoscopic choledochoduodenostomy in the management of benign biliary obstruction. J Gastrointestin Surg. 2012;16:801–805.CrossRefGoogle Scholar
  3. 3.
    Malik AA, Rather SA, Bari SUL, Wani KA. Long-term results of choledochoduodenostomy in benign billiary obstruction. World J Gastrointest Surg. 2012;4(2):36–40.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Cotton PB, Geenen JE, Sherman S, Cunningham JT, Howell DA, Carr-Locke DL, Nickl NJ, Hawes RH, Lehman GA, Ferrari A, Lichtenstein DR, Baillie J, Jowell PS, Lail LM, Evangelou H, Bosco JJ, Hanson BL, Hoffman BJ, Rahaman SM, Male R. Endoscopic sphincterotomy for stones by experts is safe, even in younger patients with normal ducts. Ann Surg. 1998;227(2):201–204.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ray AA, Davies ET, Duvdevani M, Razvi H, Denstedt JD. The management of treatment-resistant biliary calculi using percutaneous endourologic techniques. Can J Surg. 2009;52(5):407–412.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Sherman S, Ruffolo TA, Hawes RH, Lehman GA. Complications of endoscopic sphincterotomy: a prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts. Gastroenterology. 1991;101(4):1068–1075.CrossRefPubMedGoogle Scholar
  7. 7.
    He J, Choti MA. Bile duct injury – acute repair. Score. Updated December 10, 2016. Accessed December 10, 2017.
  8. 8.
    Shelat VG, Chan CY, Liau KH, Ho CK. Laparoscopic exploration can salvage failed endoscopic bile duct stone extraction. Singapore Med J. 2012;53(3):313–317.PubMedGoogle Scholar
  9. 9.
    DuCoin C, Moon RC, Teixeira AF, Jawad MA. Laparoscopic choledochoduodenostomy as an alternate treatment for common bile duct stones after Roux-en-Y gastric bypass.Surg Obes Relat Dis. 2014;10:647–653.CrossRefPubMedGoogle Scholar
  10. 10.
    Overby DW, Richardson W, Fanelli R. Choledocholithiasis after gastric bypass: a growing problem. Surg Obes Relat Dis. 2014;10(4):652–653.CrossRefPubMedGoogle Scholar
  11. 11.
    Franceschi D, Brandt C, Margolin D, Szopa B, Ponsky J, Priebe P, Stellato T, Eckhauser M. The management of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Am Surg. 1993;59(8):525–532.PubMedGoogle Scholar
  12. 12.
    Tinoco R, El-Kadre L, Tinoco A. Laparoscopic choledochoduodenostomy. J Laparoendosc Adv Surg Tech. 1999;9(2):123–126.CrossRefGoogle Scholar
  13. 13.
    Chander J, Mangla V, Vindal A, Lal P, Ramteke VK. Laparoscopic choledochoduodenostomy for biliary stone disease: a single-center 10-year experience. J Laparoendosc Adv Surg Tech. 2012;22(1):81–84.CrossRefGoogle Scholar
  14. 14.
    Jeyapalan M, Almeida JA, Michaelson RL, Franklin Jr. ME. Laparoscopic choledochoduodenostomy: review of a 4-year experience with an uncommon problem. Surg Laparosc Endosc Percutan Tech. 2002;12(3):148–153.CrossRefPubMedGoogle Scholar
  15. 15.
    Tang CN, Siu WT, Ha JPY, Li MKW. Laparoscopic choledochoduodenostomy: an effective drainage procedure for recurrent pyogenic cholangitis. Surg Endosc. 2003;17:1590–1594.CrossRefPubMedGoogle Scholar
  16. 16.
    Qadan M, Clarke S, Morrow E, Triadafilopoulos G, Visser B. Sump syndrome as a complication of choledochoduodenostomy. Dig Dis Sci. 2012;57(8):2011–2015.CrossRefPubMedGoogle Scholar
  17. 17.
    Cuschieri A, Wood RAB, Metcalf MJ, Cumming JGR. Long-term experience with transection choledochoduodenostomy. World J Surg. 1983;7:502–504.CrossRefPubMedGoogle Scholar
  18. 18.
    Rose JB, Bilderback P, Raphaeli T. Use the duodenum, it’s right there: a retrospective cohort study comparing biliary reconstruction using either the jejunum or the duodenum. JAMA Surg. 2013;148(9):860–865.CrossRefPubMedGoogle Scholar
  19. 19.
    Panis Y, Fagniez PL, Brisset D, Lacaine F, Levard H, Hay J. Long term results of choledochoduodenostomy versus choledochojejunostomy for choledocholithiasis. The French Association for Surgical Research. Surg Gynecol Obstet. 1993;177(1):33–37.PubMedGoogle Scholar
  20. 20.
    Targarona EM, Pros I, Martinez J, Trias M, Ayuso RMP, Ros E, Tres J, Bordas JM. Randomised trial of endoscopic sphincterotomy with gallbladder left in situ versus open surgery for common bile duct calculi in high-risk patients. Lancet. 1996;347(9006):926–929.CrossRefPubMedGoogle Scholar
  21. 21.
    Cruz-Munoz Ndl, Koniaris LG. Alternative port site selection (APSS) for improved cosmesis in laparoscopic surgery. J Gastrointest Surg. 2010;14(12):2004–2008.CrossRefGoogle Scholar
  22. 22.
    Koniaris LG, Zimmers-Koniaris TA, Lillemoe KD, Sachs SM, Riggle K. A method for easier laparoscopic cholangiography and common bile duct exploration. J Am Coll Surg. 2000;190(6):752–756.CrossRefPubMedGoogle Scholar
  23. 23.
    Chan OCY, Tang CN, Lai ECH, Yang GPC, Li MKW. Robotic hepatobiliary and pancreatic surgery: a cohort study. J Hepatobiliary Panceat Sci. 2011;18(4):471–480.CrossRefGoogle Scholar
  24. 24.
    Gilbert A, Doussot A, Ortega-Deballon P, Rostain F, Rat P, Facy O. Robot-assisted choledochoduodenostomy: a safe and reproducible procedure for benign common bile duct obstruction. Dig Surg. 2017;34:177–179.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Joshua K. Kays
    • 1
    Email author
  • Leonidas G. Koniaris
    • 1
  • Daniel P. Milgrom
    • 1
  • Attila Nakeeb
    • 1
  1. 1.Department of SurgeryIndiana University School of MedicineIndianapolisUSA

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