DOI: http://dx.doi.org/10.18203/2349-2902.isj20203776

Study on 60 cases of common bile duct stone, there different modality of management and its inference

Sovat Lal Ahirwar

Abstract


Background: The aim of the study was to determine the best treatment modality for common bile duct stone become more challenging as large number of options available such as endoscopic, laparoscopic or open surgical methods, we need to choose specific therapy according to patient’s clinical conditions, and individual expertise.

Methods: It is prospective study including 60 patient having common bile duct stone along with gall bladder stone, its different modality of management and its inference, conducted in Bhopal Memorial Hospital and Research Centre, Bhopal, during period of January 2017 to January 2020.

Results: In 60 cases 41 patients undergoes to endoscopic retrograde cholangio pancreatography (ERCP) first, stone successfully removed in 34 patients and stent placed, one patients developed pancreatitis after ERCP, managed conservatively, In 6 patients retained stone after ERCP procedure, one patients developed surgical emphysema after procedure, managed with ICD and conservatively, and one patient had bleeding during sphincterotomy so its procedure abandoned and one of the patient failed to cannulate common bile duct (CBD).  21 patients undergo laparoscopic common bile duct explorations, 2 lap CBD exploration converted to open CBD exploration with cholecystectomy, due to adhesion at hepatocystic triangle. Five patients undergoes open CBD exploration, in one patient hepaticojejunostomy was done as patient was having CBD stone with stricture. No mortality during and after procedure.

Conclusions: Management of CBD stone is depends upon individual expertise and available modality. If surgeons are expertise then lap CBD exploration with cholecystectomy without attempting to ERCP guide stone removal is best approach in majority of patients.


Keywords


Common bile duct stone, Laparoscopic CBD exploration

Full Text:

PDF

References


Johnson AG, Hosking SW. Appraisal of the management of bile duct stones. Br J Surg. 1987;74:555-60.

Acosta MJ, Rossi R, Ledesma CL. The usefulness of stool screening for diagnosing cholelithiasis in acute pancreatitis. A description of technique. Am J Dig Dis.1977;22:168-72.

Murison MS, Gartell PC, McGinn FP. Does selective preoperative cholangiography result in missed common bile duct stones?. J R Coll Surg Edinb.1993;38:220-4.

Rosseland AR, Glomsaker TB. Asymptomatic common bile duct stones. Eur J Gastroenterol Hepatol. 2000;12:1171-3.

Sarli L, Pietra N, Franze A, Colla G, Costi R, Gobbi S, et al. Routine intravenous cholangiography, selective ERCP, and endoscopic treatment of bile duct stones before laparoscopic cholecystectomy. Gastrointest Endosc.1999;50:200-8.

Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc. 2002;56:165-9.

Abboud PA, Malet PF, Berlin JA, Staroscik R, Cabana MD, Clarke JR, et al. Predictors of common bile duct stones prior to cholecystectomy: a metaanalysis. Gastrointest Endosc. 1996;44:450-5.

Eisen GM, Dominitz JA, Faigel DO, Goldstein JL, Kalloo AN, Petersen BT, et al. An annotated algorithm for the evaluation of choledocholithiasis. Gastrointest Endosc. 2001;53:864-6.

Kohut M, Nowak A, Marek T, Chávez MÁ. Evaluation of probability of bile duct stone presence by using of non-invasive procedures. Pol Arch Med Wewn. 2003;110:691-702.

Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, JacobsonBC, et al. Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. Complications of ERCP. Gastrointest Endosc. 2003;57:633-8.

Mark DH, Flamm CR, Aronson N. Evidence-based assessment of diagnostic modalities for common bile duct stones. Gastrointest Endosc. 2002;56:190-4.

Cohen S, Bacon BR, Berlin JA, Fleischer D, Hecht GA, Loehrer PJ, et al. National Institutes of Health Stateof-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14-16, 2002. Gastrointest Endosc. 2002;56:803-9.

Morris S, Gurusamy KS, Sheringham J. Cost-effectiveness Analysis Endoscopic ultrasound versus Magnetic resonance cholangiopancreatography in patients with suspected common bile duct stone. PLoS ONE. 2015;10:e0121699.

Zinner MJ, Stanley WA. choledocholithiasis and cholagitis maingot’s abdominal operations 12th Edition : McGraw-Hill; 2013: 1028-1040.

Petelin JB. Laparoscopic common bile duct exploration. Surg Endosc. 2003;17:1705-15.

Tai CK, Tang CN, Ha JP, Chau CH, Siu WT, Li MKW. Laparoscopic exploration of common bile duct in difficult choledocholithiasis. Surg Endosc. 2004;18:910-4.

Cuschieri A, Croce E, Faggioni A. EAES ductal stone study. Preliminary findings of multi-center prospective randomized trial comparing two-stage vs. single-stage management. Surg Endosc. 1996;10:1130.

Cuschieri A, Lezoche E, Morino M, Toouli J, Faggi-oni A, Ribeiro VM. Multicenter prospective randomized trial comparing two-stage vs. single stage management of patients with gallstone disease and ductal calculi. SurgEndosc. 1999;13:952.

Decker G, Borie F, Millat B, Deleuze A, Drouard F, Guillon F, et al. One hundred laparoscopic choledochotomies with primary closure of the common bile duct. SurgEndosc. 2003;17:12-8.

Isla AM, Griniatsos J, Karvounis E, Arbuckle JD. Advantages of laparoscopic stented choledochor-rhaphy over T-tube placement. Br J Surg. 2004;91:862-6.

Desari BV, Tan CJ, GurusamyKS. Surgical versus endoscopic treatment of bile duct stone. cochrane data base syst rev. 2013;(12):CD003327.

Rhode M, Sussman L, Cohen L, Lewis MP. Randomised trial of Laparoscopic exploration of common bile ductversus postoperative endoscopic retrograde cholangiography for common bile duct stone. Lancet. 1998;351:159-61.