A prospective, randomized clinical investigation of cholecystoenterostomy and choledochoenterostomy

Am J Surg. 1988 Mar;155(3):411-4. doi: 10.1016/s0002-9610(88)80102-8.


A prospective, randomized clinical trial was conducted to assess the efficacy of bilioenteric bypass in noncalculous distal biliary obstruction. Thirty-one patients required bypass for either malignant obstruction or chronic pancreatitis and were randomized into two groups: cholecystoenterostomy or choledochoenterostomy with cholecystectomy. Nine bypasses failed after cholecystoenterostomy and two after choledochoenterostomy (p less than 0.04). Eight of the 9 failures occurred in the subgroup of 22 patients with malignant biliary obstruction. In this subgroup, five bypasses failed within 90 days of operation, all after cholecystoenterostomy (p = 0.03 compared with choledochoenterostomy). The results indicate that choledochoenterostomy is the superior operation for malignant distal biliary obstruction. Additional studies will be necessary to identify the procedure of choice for benign noncalculous obstructions.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Carcinoma / complications
  • Cholecystostomy* / adverse effects
  • Choledochostomy* / adverse effects
  • Cholestasis, Extrahepatic / etiology
  • Cholestasis, Extrahepatic / surgery*
  • Chronic Disease
  • Clinical Trials as Topic
  • Humans
  • Middle Aged
  • Pancreatic Neoplasms / complications
  • Pancreatitis / complications
  • Prospective Studies
  • Random Allocation