Surgical Management of Common Bile Duct Stones at Saint Paul's Hospital; Addis Ababa; Ethiopia

Background: This study was aimed at evaluating the trend and outcome of surgical management of choledocholithiasis in St. Paul Teaching Hospital Addis Ababa; Ethiopia. Methods: This was a clinical based retrospective analysis. The operation register was used to identify the cases that were operated for biliary lithiasis. Their clinical records were obtained from the record office of the hospital and data collected and recorded on a predesigned format. Data was analyzed by SPSS statistical software. Pearson's chi-square test was used for statistical analysis. P-value 0.05 was considered significant. Results: A total of 1230 underwent open cholecystectomy over 5 year period of which 98 patients where found to have choledocholithiasis constituting 7. Of the 98 patients who underwent common bile duct (CBD) exploration; the records of 78 patients were found and made the basis of this analysis. Fifty-nine (75.6) patients were females and 19(24.4) were males; with a male to female ratio 1: 3. The mean age was 49.15 years. The most common symptoms were right upper quadrant pain and jaundice. The most frequent physical findings was right upper quadrant tenderness. Choledocholithotomy with T-tube insertion was done in 39 patients; side to side choledochoduodenostomy in 34 patients; and hepaticojejunostomy in 5 patients. Twenty-four (71.6) choledochoduodenostomy patients were discharged in less than ten days after operation while 36(87.1) of those with T-tube were discharged after 10 days (p0.019). The re-operation rate was 12.8for the T-tube insertion group and 2.9for choledochoduodenostomy patients. There were 3(8.8) deaths in the former and 1(2.9) in the group of choledochoduodenostomy. The overall complication rate was 11 (30.6) for the T-tube insertion and 3 (8.8) for the choledochoduodenostomies. Conclusion: Choledochoduodenostomy is a better option than Choledocholithotomy with T-tube insertion in the treatment of choledocholithiasis in African setting. We recommend choledochoduodenostomy (CD) for multiple CBD calculi; big calculi in the CBD; much dilated CBD (2cm); primary CBD stones; hepatic stones; recurrent stones; and elderly patients where the size of the CBD is 15mm and above

Conversions in laparoscopic cholecystectomy--need for a new nomenclature.

Reasons for conversion from laparoscopic cholecystectomy (LC) to open cholecystectomy (OC) were analysed in 47 patients. In 35 patients, the surgeon converted LC to OC by choice because of difficult anatomy or difficult pathology while in 12 patients the surgeon was forced to convert from LC to OC because of complications. We propose that conversions from LC to OC should be classified into two groups-"conversions-by-choice" and "conversions-per-force".

Profilaxis antimicrobiana en colecistectomía electiva de bajo riesgo: resultados de un estudio prospectivo, aleatorio y doblemente a ciegas / Antimicrobial prophylaxis in low risk elective cholecystectomy: results of a prospective: randomized, double-blind study

Objetivo: Determinar la eficacia de la profilaxis antimicrobiana con cefradina en la prevención de complicaciones infecciosas posteriores a colecistectomía electiva de bajo riesgo. Diseño: Estudio prospectivo, de asignación aleatoria y controlado con placebo, conducido de junio de 1987 a noviembre de 1990. Sede: Hospital universitario de investigación. Pacientes: Un otal de 141 pacientes con diagnóstico de colecistitis crónica litiasica (CCL), menores de 70 años de edad y sin factores de riesgo divididos al azar en dos grupos: Grupo de estudio 69 pacientes y grupo testigo 72. Intervenciones: Los pacientes del grupo de estudio recibieron una dosis única de cefradina 2 gramos intravenosos al momento de la inducción anestésica, los pacientes del grupo testigo recibieron agua destilada. Durante la intervención quirúrgica se tomaron muestras de bilis para cultivo. Después de la operación, los pacientes fueron seguidos por un periodo de 30 días. Mediciones y Resultados: La mayoría de los pacientes del grupo experimental y del grupo testigo se sometío a colescistectomía con o sin colangiografía (93 por ciento y 90 por ciento respectivamente). Doce pacientes requirieron exploración de la vía biliar por hallazgos transoperatorios o evidencia rediológica de coledocolitiasis. Se obtuvieron muestras de bilis en 124 pacientes y el 16 por ciento de los cultivos fueron positivos, la bacteria más frecuente fue E. coli seguida por bacilos gram negativos aeróbicos y especies de streptococcus. Cinco pacientes del grupo testigo (7 por ciento) desarrollaron infección de herida, ningún paciente del grupo experimental presentó esta complicación (P. exacta de Fisher de una cola P=< 0.05). Otras complicaciones fueron similares en ambos grupos así como los tiempos de estancia pre y postoperatoria. Conclusiones: Concluimos que una dosis única de cefradina administrada en forma intravenosa antes de la operación proveé profilaxis efectiva en contra de la infección de herida en pacientes de bajo riesgo sometidos a colecistectomía electiva.