- Choledochoduodenal anastomosis is usually indicated in patients with multiple stones in the hepatic bile ducts that are dilated and in which one cannot be sure that some calculi may remain following surgery.
- The procedure is also indicated in patients who are being subjected to a reoperation for residual stones in the common hepatic duce
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A very precise indication is that of primary stones in the common hepatic duct.
- In patients with chronic pancreatitis with compression of the retropancrcatic bile duct.
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In patients wifa fibrosis of the sphincter of Oddi with a very diiated bile duct, it is preferable to do a choledochoduodenal anastomosis instead of a sphincteroplasty. Very dilated bile ducts empty better with choledochoduodenal anastomosis than with sphincteroplasry.
- In older patients or those with high risk it is preferable to perform a choledochoduodenal anastomosis than a sphinctcroplasty because it is an easier operation it is performed in a shorter period of rime, it is well tolerated, and it carries a lower morbidity and mortality rate.
- There are surgeons who believe that choledochoduodenal anastomosis is indicated in malignant obstructive lesions in the distal end of the common bile duct. The author, as well as other surgeons believes that this is not a correct indication because the carcinoma, as it grows, wif rapidly obstruct the anastomosis. A more adequate operation in these cases is that of hepancojejunostom.
- Some surgeons believe that choledochoduodenal anastomosis is indicated in cases of periarnpullary duodenal diverticula in order to avoid the risk of damage to the arnpulla during the removal of the diverticulum, This author, on the other hand, believes that the best treatment for symptomatic duodenal periarnpullary diverticula is diverticulectomy.
However, the sole presence of a perlampullary diverticulum does nor increase the diameter of the common bile duct to facilitate the performance of the anastomosis with the duodenum. Ir is important to point out that in numerous occasions the author as well as other surgeons has proven that many choledochoduodenal anastomoses have been unnecessarily.