Comparing Perioperative Outcomes of Choledochoduodenostomy and Roux-en-Y Hepaticojejunostomy in Difficult Choledocholithiasis: The Experience of a Brazilian Tertiary-Level University Hospital

INTRODUCTION: Choledocholithiasis may cause cholangitis, pancreatitis, or liver failure. Although endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment, it may fail or be unavailable, making biliary-enteric anastomoses such as choledochoduodenostomy (CDD) and Roux-en-Y hepaticojejunostomy (HJ-RY) important surgical alternatives. METHODS: This single-center retrospective study (2011-2023) included 46 patients who underwent CDD or HJ-RY for choledocholithiasis, either as primary treatment or after failed/unavailable ERCP. The primary endpoint was 30-day morbidity; secondary endpoints included severe morbidity (Clavien-Dindo ≥3) and mortality. Clinical, laboratory, operative, and postoperative variables were analyzed. Multivariable logistic regression identified independent predictors of 30-day morbidity, severe morbidity, and mortality. RESULTS: The mean age was 53 years, with 58.7% females. Prior cholangitis occurred in 47.2% and previous ERCP in 60.9% of cases. Compared with HJ-RY, CDD was performed in older patients (58 ± 15 vs. 45 ± 17 years; p=0.039) and those with larger bile ducts (2.1 ± 0.4 vs. 1.6 ± 0.6 cm; p=0.005). No significant differences were found between techniques or between patients with and without prior ERCP in morbidity, severe complications, or mortality. In multivariable analysis, no variable independently predicted 30-day morbidity or mortality, though cholangitis showed a trend toward higher risk and bile duct diameter toward protection. CONCLUSION: CDD and HJ-RY are safe and effective options for choledocholithiasis, with comparable short-term outcomes. The choice should rely on anatomical and intraoperative factors rather than expected differences in perioperative morbidity.