This video demonstrates revisional biliary bypass surgery on a patient suffering from recurrent cholangitis following choledochoduodenostomy.

The patient is a 66 year old-female who underwent a cholecystectomy in 1972. A choledochoduodenostomy was performed concurrently for unclear reasons. Over the last 5-10 years the patient had repeated episodes of cholangitis. Endoscopic retrograde cholangiography performed during these episodes demonstrated a widely patent biliary bypass with food debris and calculi in the distal duct. Despite initial improvement following biliary sphincterotomy, her symptoms would recur. Our impression was that she was suffering from a sump syndrome in which food debris was getting trapped in her distal bile duct. Therefore, we advised conversion to a Roux-En-Y hepaticojejunostomy.

Conversion to a Roux-En-Y hepaticojejunostomy was performed as planned. Copious debris was evacuated from her distal bile duct at the time of operation. Her intraoperative and postoperative courses were uneventful and she was discharged home on postoperative day 7.

The video describes the etiology and remedial surgery for recurrent cholangitis caused by sump syndrome following choledochoduodenostomy. Early recognition of this problem and timely surgical intervention can prevent unnecessary morbidity such as that suffered by the patient in this case.