The clinical features, indications and operative results in a consecutive series of 246 patients who underwent
choledochoduodenostomy (CDD) and
transduodenal sphincterotomy or sphincteroplasty (
TDS) over a period of ten years (1972 to 1981) were reviewed. The over-all mortality for CDD was ten of 190 patients (5.3 per cent) and three of 56 patients for
TDS (5.4 per cent). The over-all major morbidity rate for these procedures was 11.6 per cent for CDD and 21.4 per cent for
TDS. This was not a statistically significant difference, but there were more elderly patients (more than 65 years old) in the CDD group (60.5 per cent) than in the
TDS group (21.4 per cent) (p less than 0.001). The major morbidity rate associated with elective operations was 10.7 per cent for CDD and 20.0 per cent for
TDS which is significant (p less than 0.05). Long term follow-up study (one to 12 years and mean of four and one-half years) revealed six patients in the CDD group with
sump syndrome or
cholangitis, or both, (3.3 per cent) and three patients in the
TDS group had
cholangitis develop (5.7 per cent). Over-all, the results compared favorably with the published results of
endoscopic sphincterotomy. We conclude that CDD is the operation of choice when a permanent biliary drainage procedure is indicated and
TDS should be reserved for instances of ampullary
gallstone impaction.