ABSTRACT
Background: Choledocholithiasis is one of the most common GI diseases seen in clinical therapeutic endoscopy practice. No unanimous consensus has been achieved for the ideal management of gall bladder and CBD stones. So both of the old and new approaches for the treatment including open surgery, laparoscopy and endoscopy are now available
Aim of the Work: This study was conducted to compare the success rate, length of hospital stay and clinical result between three modalities used for management of common bile duct stones
Patients and Methods: A total of 60 patients with symptomatic gall stones and common bile duct stones were randomized to either treatment option. Preoperative diagnosis was done by ultrasound and confirmed by ERCP. The patients were randomized into 3 groups [20 patients, each]. Group ? underwent laparoscopic cholecystectomy and open common bile duct exploration [CBDE] at the same time. Group II underwent endoscopic sphincterotomy [ES] with stone clearance, followed by laparoscopic cholecystectomy 4-6 week later. Group III underwent surgical open cholecystectomy with open exploration of common bile duct [CBD] and removal of stones with stent of CBD
Results: The ductal stone clearance rates were higher in Group I and III when compared to Group II [90%, 80% and 95%, respectively]. There were no statistically significant differences as regard postoperative stay. Mean hospital stay was significantly shorter in Group I compared with Groups II and III 4.7+/-2.4 days [range 2-9days], 9.9+/-7.7 days [range 2-34 days] and 4.8 +/-1.7dayes [range 3-10days]. As regard postoperative mortality and morbidity. There was only one case of postoperative mortality [5%] in a patient belonging to Group III. This patient developed renal failure after surgery. Wound infection was much more frequent in Group II patients [10%] than in group 1 and 3 [5%]. The post-operative morbidity was more frequent in Group III [25%] than in Group I and II [10 and 22.5 %, respectively]
Conclusion: When compared LCBDE during LC with preoperative ERCP with ES followed by LC and open surgery, LCBDE during laparoscopic cholecystectomy allow high rate of CBD clearance, decrease of morbidity, also it was shorter hospital stay. So LCBDE during LC solve 2 problems during same anesthesia with high success rate and may be employed successfully