ABSTRACT
Forty patients [16 males and 24 females] were admitted to the Gastrointestinal Surgery Unit of the Main Alexandria University Hospital. All patients were documented by ultrasound to have large common bile duct [CBD] stones 71=15 mm in largest diameter. To compare the success rate, complications and hospital stay of endoscopic and surgical techniques used in the treatment of large common bile duct stones. The patients were randomly divided into 2 groups [group A] underwent endoscopy and group [B] underwent surgical interference. Each group was 20 in number of patients. The commonest patient's manifestations were abdominal pain and jaundice [100%], 13 patients [33%] had attacks of cholangitis. The mean laboratory test values were insignificant between both groups. The diameter of the CBD stone by the ultrasound ranged from 15 mm to 31 mm in largest diameter with a mean of 18.4 +/- 3.882 mm. Endoscopic management was done successfully in 18 patients [90%] while 2 patients [10%] failed to he managed by endoscopic retrograde cholangio-pancreatography and ERCP and underwent surgical interference. Spontaneous passage of the stones immediately after endoscopic sphincterotomy occurred In 3 patients [15%], Balloon extraction was done in 7 patients [35%,] while Dormia basket was used in 4 patients [20%,]. ERCP failed in 2 patients [10%.]: one of them had very large CBD stone [31 mm] that is largest than the maximum size of the lithotripsy basket. In the second patient, the papilla was almost flat with rudimentary intraluminal part of the CBD that was difficult to cannulate after unsuccessful trial for 40 minutes. The complications occurred in group 2 patients [20%] in the form of cholangitis. The mean hospital stay of group [A] was 1.92 +/- 1.71. Surgical management was done succesfully in 19 patients [95%]. Supraduodenal choledochotomy and T-tube drainage was performed in 6 patients [30%]; one of them [5%] had missed stone and managed by ERCP. Choledocho-duodenostomy was performed in 12 patients [60%] while transduodenal sphincteroplasty was performed in one [5%] patient. Complications occurred in 5 patients [26.3%], which were more than group [A]; in the form of wound infection. biliary leakage hepatic encephalopathy or burst abdomen. Mean hospital stay of group [B] was 10.4 +/- 2.32 days was significantly longer than of group [A]. Post-endoscopic and post-operative tests showed significant decrease in the mean values of liver functions and enzymes. Ultrasonography was done to all successfully managed patients [2 weeks after intervention] and revealed complete clearance of the CBD. ERCP is usually successful in the management of large CBD stones. Hospital stay and complications of endoscopic management are much less than surgical management The surgeon should try endoscopic management of large CBD stones using all its techniques prior to resort to surgical management of large CBD stones