ABSTRACT
Introduction: Management of common bile duct stones(CBDS) presents a surgical challenge since it is the majorcause of hepatobiliary morbidity and complications. The aimof the study was to evaluate the clinical outcome for CBDstone and evaluate the treatment modality.Material and Methods: This retrospective study was done in30 cases of Common bile duct stone for period of 1 year. All 30patients included in the study were appropriately investigatedby laboratory investigations, USG, CT scan and MRCP.Results: Out of 30 patients included in the study, 26 hadundergone successful ERCP and had successful clearance ofCBD which were followed by Laparoscopic cholecystectomy.2 patients had failed ERCP clearance, out of which 1 patienthad undergone re-ERCP with successful clearance of the stone.The other 1 patient had to undergo Open CBD explorationfollowed by cholecystectomy. 2 patients with CBD stonegreater than 2 cm had to undergo direct CBD explorationwithout undergoing ERCPConclusion: Appropriate identification of CBD stone size,location, number and CBD diameter associated with featuresof cholangitis, jaundice and pancreatitis is essential. It isa complicated procedure requiring a step-wise strategicapproach. The gold standard for the removal of CBD stoneis ERCP followed by laparoscopic cholecystectomy.Commonbile duct exploration is considered in patients with failedclearance of CBD following ERCP OR CBD stone size > 2cm.
ABSTRACT
Introduction: Management of common bile duct stones(CBDS) presents a surgical challenge since it is the majorcause of hepatobiliary morbidity and complications. The aimof the study was to evaluate the best line of treatment for CBDstone and complications related to every approach.Material and Methods: This retrospective study includespatients with CBDS who were treated with conservativetreatment or endoscopic stone extraction followed bylaparoscopic cholecystectomy (LC). Primary outcome wassuccessful clearance of common bile duct and secondaryoutcomes were complications, total cost and hospital stay.Results: Out of 25 patients, 13 were treated by ERCP(Endoscopic Retrograde Cholangio Pancreatography) and12 by Conservative approach. There was complete clearanceof CBDS in 10 (76%) cases out of 13, in the endoscopicretrograde cholangiopancreatography (ERCP) group and inthe remaining 3 patients, the Common bile duct stone wasremoved by the trans-cystic exploration. In the conservativegroup, there was complete clearance of CBDS in 8 (66%)cases, and in the remaining 4 (33%)patients, the common bileduct stone was removed by the transcystic exploration.Conclusion: Management of CBDS represents a surgicalchallenge. CBDS increases the technical difficulty of ERCPand increases the risk of PEP. Conservative managementof CBDS avoids the risks associated with ERCP and isalso effective in clearing CBDS so one should consider aconservative line of treatment in CBDS in order to decreasethe cost and avoid unnecessary ERCP.
ABSTRACT
Background: Beta thalassemia continues to be a significant burden to Western India particularly Saurashtra region of Gujarat. Since cost of treatment is high emphasis must be shifted from treatment to prevention that includes mass screening as most effective tool including RBC indices & peripheral blood smear. These tests have limited availability, re quire sophisticated equipments and are expensive. Thus, there is need for simple, low cost and reliable test which can be used in absence of sophisticated equipments. The present study has evaluated the validity of such test: indirect bilirubin and urine urobilinogen. Study had two objectives: 1) Estimation of indirect bilirubin, urobilinogen and Shine & Lal Index. 2) Comparing specificity and sensitivity of above test with HbA2 electrophoresis. Methods: The present study was conducted on 100 (n=100) subjects in blood bank, department of pathology, government medical college Rajkot, Gujarat, India. In first group 50 subjects (Thalassemia minor) were selected while in second group 50 (n2=50) normal individuals from hospital staff were selected. Complete-haemogram, serum-direct, indirect and total bilirubin, urine urobilinogen and their sensitivity and specificity were calculated. Results: Of the 50 cases in test group, 41 had higher Indirect Bilirubin level (>0.7 mg/dl), 35 had high urobilinogen level (>1 mg/dl). In control group out of 50 cases, 3 had high indirect bilirubin levels, 4 had high urobilinogen levels. Indirect-bilirubin had sensitivity of 82%, specificity of 94%. Urobilinogen showed sensitivity of 70% & specificity of 92%. Conclusion: Indirect bilirubin and urine-urobilinogen is a valuable, cost-effective screening test for beta-thalassemia-trait with sensitivity & specificity comparable to RBC indices.