[Choledochoduodenal anastomosis--pro and contra].

Abstract Choledochoduodenostomy (CDS), suggested by T. Roth, and performed for the first time by O. Sprengel (1891), became a definitely affirmed operation after the publications of F. Sasse (1913). From purely anatomical standpoint, CDS contributes to bypass all problems relating to obstruction in the retroduodenal, transpancreatic and intramural segments of the hepatocholedochus with a wide orifice for spontaneous passage of eventual newly formed or residual concrements being secured. The basic indications for performing CDS include: multiple concrements in the extrahepatic biliary ducts, ampullar stenosis, cholangitis, chronic pancreatitis, cyst induced enlargement of choledochus and the like. It is worth noting that in most patients more than a single indication are present. The major shortcomings of the procedure with a reference to the long-term results are attributed to potentialities of cholangitis and cholangiohepatitis development, and "blind sac" formation between the anastomosis and p. Vateri. It is established that all patients with poor post-CDS results have stenosis of the anastomosis, or else, the restoration of papillary patency fails (endoscopically confirmed), i.e. they are most frequently a sequel of technical errors. CDS is a safe, readily performed and effective surgical procedure with few (sporadic) postoperative complications, including patients undergoing long-term follow-up study.