Choledochoduodenostomy versus T-tube drainage in patients have stones in common bile duct with risk factors of post-operative missed stones

Authors

  • Mohamed M. Ali Department of General Surgery, Sohag University, Sohag, Egypt
  • Mena Zarif Helmy Department of General Surgery, Sohag University, Sohag, Egypt
  • Emad Gomaa Department of General Surgery, Sohag University, Sohag, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20195391

Keywords:

T-tube, Missed stones, CBD exploration

Abstract

Background: Residual or missed stones of common bile duct (CBD) and ascending cholangitis after CBD exploration are major biliary surgery problems. Repeated biliary tract interventions for correction of complications are catastrophic on both patients and surgeons.

Methods: This is a prospective study of 83 patients which compares two methods for surgical management of CBD stones between June 2016 to May 2018. Group I included 43 patients who were managed by CBD exploration followed by insertion of T tube, the risk factors of the incidence of missed retained stone in CBD were multiple stones in CBD and hugely dilated CBD (>15 mm).The second method was choledochoduodenal anastomosis for patients having the same previous risk factors (Group II) which included 40 patients. Postoperative follow up was for 12 to 18 months.

Results: In group I, 6 patients developed residual stones in CBD, reoperation was required for 3 of them and endoscopic retrograde cholangiopancreatography with sphincterotomy for another 3 patients, while in the other group (group II) 2 patients suffered from ascending cholangitis and are managed conservatively. No missed or residual CBD stones were developed and no patients need reoperation.

Conclusions: With choledochoduodenostomy in patients with multiple CBD stones or markedly dilated CBD the incidence of missed or retained stones in CBD was reduced.

Author Biography

Mohamed M. Ali, Department of General Surgery, Sohag University, Sohag, Egypt

general surgery department

References

Mokhtar AM. Cholelithiasis in the western region of Saudi Arabia. East Afr Med J. 1990;67(4):286-90.

Petelin JB, Pappas CS. Gallbladder and Biliary Tract. In: Siddiqui A, ed. Current surgical therapy. 8th ed. Elsevier (Mosby); 2004: 383-458.

Oddsdottir M, Hunter JG. Gallbladder and the extrahepatic biliary system. Schwartz’s Principles of Surgery. 8th ed. McGraw Hill; 2005: Chapter 31.

Moreaux J. Traditional surgical management of common bile duct stones: a prospective study during a 20-year experience. Am J Surg. 1995;169(2):220-6.

Krusamy KS, Samrai K. Primary closure versus T-tube drainage after open common bile duct exploration. Cochrane Data Base System Rev. 2007;24(1):CD005640.

Fry DE, Buchignani E, Polk HC, Ahmad W, Harbrecht PJ. Applications of choledocho-duodenostomy in biliary tract obstruction. Am Surg. 1982;48(4):149-52.

Berlatzky Y, Freund HR. Primary choledochoduodenostomy for benign obstructive biliary tract disease. J Clan Gastroenterol. 1990;12(4):420-2.

Bjerkeset T, Edna TH, Drogset JO, Svinsas M. Traditional surgical treatment of chole-docholithiasis. An analysis of a 10-year material 1980-89. Tidsskr-Nor-Laegeforen. 1997;117(20):2939-41.

Lygidakis NJ. A prospective randomized study of recurrent choledocholithiasis. Surg Gynecol Obstet. 1982;155(5):679-84.

Khalid K, Safi M, Dart HM, Durrani KM. Choledochoduodenotomy: reappraisal in endoscopic era. ANZ J Surg. 2008;78(6):495-500.

Miller HI. Treatment of common bile duct stones. Am J Gastroenterol. 2008;42(3):312-6.

Sharma P, Klaasen H, Skeidsvoll H, Peirzynowski S, Blix I. Transduodenal sphincterotomy for stenosing papillitis and massive choledocholithiasis after Billroth II gastrectomy. Ann R Coll Surg Engl. 1995;77(2):90-3.

Lygidakis NJ. Surgical approaches to postcholecystectomy choledocholithiasis. Arch Surg. 1982;117(4):481-4.

Horntrich J. Status determination in discussion of benign stenosis of Vater’s papilla. Gastroenterol J. 1990;50(2):101-4.

Pecis C, Sgroi G, Castelli F, Stringhi E. Surgical treatment of lithiasis of the common bile duct: our experience. Minerva Chir. 1990;45(10):711-3.

Downloads

Published

2019-11-26

Issue

Section

Original Research Articles