Analysis of the management of choledocholithiasis and it’s outcome with the role of preoperative endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography
DOI:
https://doi.org/10.18203/2349-2902.isj20192146Keywords:
Choledocholithiasis, Dilated common bile duct, Laparoscopic, Cholecystectomy, Successful removal of the stone by ERCPAbstract
Background: Choledocholithiasis implies stones in the common bile duct (CBD). Most of the common bile duct stones are those that have passed into the bile duct from the gall bladder. About 20 to 25% of patients above the age of 60 with symptomatic gall stones are likely to have stones in the CBD. To analyse the role of ERCP and MRCP in the management of choledocholithiasis.
Methods: About 60 patients who are attending the General Surgery OPD of Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India from the October 2017-March 2018 were included in the study with confirmed common bile duct stones with or without gall stones were chosen. patients were categorized into group A- who has undergone a successful ERCP followed by laparoscopic cholecystectomy and group B- who underwent open cholecystectomy with CBD exploration.
Results: Ultrasonography was done in 57 patients, of which 41 patients showed CBD stones (71.93%), 12 patients showed dilated CBD in the presence of cholelithiasis (21.05%) and in the remaining 4 patients (7.01%) this investigation showed only cholelithiasis. Since clinical condition warranted, authors proceeded with further hepatobiliary imaging, which revealed choledocholithiasis.
Conclusions: Magnetic resonance cholangio pancreatography can also be used for follow up of the patients with choledocholithiasis after therapy, to look for the presence of retained stones, since it can detect stones even in the size as small as 2 mm. Selective use of intraoperative choledochoscopy in suspected cases helps in reducing the incidence of retained stones.
References
Bailey ME. Endotoxin, bile salts and renal function in obstructive jaundice. Brit J Surg. 1989;63:774-8.
Baron RL. CBD stones, reassessment of criteria for CT diagnosis. Radiology. 1988;162:419-24.
Ginsberg GG, Michael L, Kochman, Norton I, Gostout CJ. Clinical GI Endoscopy. Chapter 46. USA: Saunders; 2012: 671–693.
Csendes A, Mitra N, Maluenda F. Counts of bacteria and myocytes of choledochal bile in controls and in patients with gall stones or CBD stones with or without acute cholangitis. Hepato Gastroenterol. 1996;42:821-6.
Csendes A, Sepulveda A, Burdiles P, Braghetto I, BastiasJ, Schutte H, et al. Common bile duct pressures in patients with CBD stones with or without acute suppurative cholangitis. Arch Surg. 1988;123:697-9.
Havard C. Non-malignant obstruction. Ann R Coll Surg Engl. 1990:26:88-93.
Hicken NF, Mc Callister AJ. Operative cholangiography as an aid to reduce the incidence of “overlooked” common bile duct stones; a study of 1,293 choledocholithotomies. Surg. 1964;55:953-8.
Jacobson K, Alexander J, Rosengren B. Cholangiovenous reflux. Acta Chirurgica Scand. 1983;123:316.
Kaplan MM, Ohkubo A, Quarone EG, Szetu D. Increased synthesis of rat liver alkaline phosphatase by bile duct ligation. International J Hepatol. 1983:56(5):368-76.
KO CW, Lee SP. Epidemiology and natural history of CBD stones and prediction of disease. GI Endosc. 2002;56:165-9.
Lipsett PA, Pitt HA. Acute cholangitis. Surg Clin North Am. 1998;70:1297.
Madden Jl. Common duct stones: their origin and surgical management. Surg Clin North Am. 1987;53:1095-113.
Nakeeb A, Commuzzie AG, Martin L. Gall stones: Genetics versus environment. Ann Surg. 2002;235:842-9.
Reynolds BM, Dargan EL. Acute obstructive cholangitis: a distinct clinical syndrome. Ann Surg. 2001;150:299.
Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Text-Book of Surgery: the Biological Basis of Modern Surgical Practice. 18th ed. 2008; 1560-1573.
Saharia PC, Zuidema GD, Cameron JL. Primary common duct stones. Ann Abdomin Surg. 1985:598-602.
Jaundice SL. A clinical approach. In: Schiff L, eds. Disease of the Liver. Philadelphia; 1993: 334-42.
Schwartz’s principles of Surgery. 9th edition. 2009: 1148-1149.
Cuschieri A, Steel RJC. Essential Surgical Practice. Higher Surg Training Gen Surg. 4th ed. 2000: 376-441.
Strasburg SM, Dorne BC, Redinger RN. Effect of alteration of biliary pressure on bile composition-a method for study: primate biliary physiology V. Gastroenterol. 2003;61:357-62.
