Choledochoduodenostomy is a safe alternative to choledochojejunostomy for biliary reconstruction in liver transplantation providing better post-operative outcomes and efficient post-operative biliary access.

Future Direction Standard biliary anastomosis in liver transplantation is donor bile duct to recipient bile duct. This duct-to-duct (D2D) anastomosis may be contraindicated or not possible. Common complications include leaks, bleeding, strictures, or need for subsequent procedures. When standard D2D anastomosis is not possible, Rouxen-Y choledochojejunostomy (CDJ) is standard practice. This is not always an option with previous abdominal operations or dense adhesions. Choledochoduodenostomy (CDD) is an alternative to Roux-en-Y reconstruction. Traditional concerns with CDD include anastomosis breakdown and infection. Our center (Bennett et al, 2009) demonstrated comparable outcomes using CDD to CDJ anastomosis. The objective of this study is to update our database with a larger cohort and evaluate longer followup.