Management Modalities of Choledocholithiasis: Endoscopic Retrograde Cholangiopancreatography Versus Open Common Bile Duct Exploration and Laparoscopic Cholecystectomy

Background and Objective : Common bile duct stone typically requires surgical intervention, which primarily involves open CBD exploration + Laparoscopic cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic CBD exploration. Open CBD exploration has multiple complications, high mortality rate and long recovery time. Methodology : A total of 50 cases presenting as choledocholithiasis between July 2018 to August 2020 were taken for study. 1st group of 20 patients underwent open cholecystectomy with open CBD exploration. 2nd group of 20 patients underwent ERCP followed by interval (6 weeks) laparoscopic cholecystectomy. Results : ERCP found to be better when compared with open CBD exploration in terms of less post-operative complications (5% in ERCP vs 20% in Open CBD exploration) and less mean duration of hospital stay(5 days in ERCP vs 8 days in Open CBD exploration). Interpretation and Conclusion : For management of CBD stone patient, gold standard treatment is ERCP followed by Laparoscopic Cholecystectomy. While in patients with incomplete clearance of CBD stone after ERCP, CBD exploration either laparoscopically or by open approach should be preferred. While in patients with CBD stone greater than 2 cm size, direct open CBD exploration is the preferred option380008

Common bile duct stones: its different aspects of presentation and management

Background: Common bile duct (CBD) stone management is a commonly occurring potential challenge for surgeons.Methods: A total of 38 patients who was admitted in admitted in surgery Department of Sri Ram Institute of Medical Sciences, Bareilly UP during the period of March 2019 to September 2019 were studied. The diagnosis was made using USG MRCP, relevant blood investigations. Patients were managed based on radiological findings by the best possible way and expertise available.Results: Out of the 38 patients, 14 (37.14%) were male and 24 (62.85%) were female. The mean age for male was 50.92 years and for female, it was 51.74 yrs. Most of the patients had pain abdomen and /or jaundice with a mean total bilirubin of 3 mg/dl. Patients are managed either by ERCP or by surgery (open/laparoscopic). Mortality is nil but morbidity is more for open procedures.Conclusions: There can be no definite algorithm for the management of CBD stones as the patients’ age, underlying general condition being the only standardizable factor with facilities for endoscopic, laparoscopic management being variably available from institution to institution and hence, necessitating tailoring the management of CBD stones depending upon the Institution’s resources.

The Safety and Feasibility of Laparoscopic Exploration of Common Bile Duct and Choledochoscope in the Magagement of Patients with Choledocholithiasis

PURPOSE: Traditionally, the main treatment for common bile duct (CBD) stones and gallstones is ERCP combined with a laparoscopic cholecystectomy (LC). However, this procedure is generally performed in 2 stages, which makes the patients uncomfortable and unsatisfied. It also can result in the need for several procedures if it fails, and sometimes the surgery is warranted. Recently in the laparoscopic era, the laparoscopic skill has been developed quite rapidly. In the case of CBD stones, there are many reports involving laparoscopic procedures. We reviewed the safety and feasibility of removing CBD stones using a laparoscope and choledochoscope. METHOD: This retrospective study reviewed 40 cases who underwent a laparoscopic cholecystectomy and choledocholithotomy for bile duct stones between Feb. 2002 and Aug. 2004. RESULTS: Of the 40 patients who underwent the laparoscopic procedure, 25 were combined with gallstones, and 12 underwent the transcystic duct approach. The average operation time and average hospital stay was 141.2 mins and 11.3 days, respectively, and the average age was 69.4 year old. There was 1 case of a major complication, where bile leakage occurred for more than 14 days due to a shincter stenosis. This case was improved by an endoscopic sphincterotomy. Of them, 30 underwent a primary closure and 8 underwent T-tube drainage, 2 underwent a biliary stent. CONCLUSION: The laparoscopic cholecystectomy and choledocholithotomy using a choledochoscope are quite safe and feasible, can reduce the patient's anxiety, and increase their level of satisfaction.

Clinical Significance of Low Junction of the Cystic Duct / 대한소화기내시경학회지

BACKGROUND AND AIMS: Recently, similar to the anomalous union of the pancreatobiliary duct (AUPBD), a low junction of the cystic duct (LJCD) was reported to be associated with the carcinogenesis of the gall bladder (GB) and other pancreatobiliary diseases. This study was designed to evaluate the clinical significance of the LJCD. METHODS: In this study all cases were performed ERCP. Three hundred and twenty two cases were selected due to their clear identification of the union area between the bile duct and the pancreatic duct, inserted area of the cystic duct, and the duodenal opening of the bile duct. The LJCD was defined that the cystic duct joins the distal bile duct between the upper margin of the pancreas and the duodenal opening of the bile duct. AUPBD was defined as a common channel greater than 15 mm in length. The clinical data was divided into four groups-normal biliary anatomy (Group 1), AUPBD (Group 2), LJCD (Group 3), and combined with AUPBD and LJCD (Group 4), and then analyzed. RESULTS: The mean age of the subjects was 56.6 with 183 male and 139 female cases. Among 322 cases, there were 7.1% (23 of 322) of AUPBD, 11.2% (36 of 322) of LJCD and 0.6% (2 of 322) of combined with AUPBD and LJCD. The clinical symptoms and the laboratory findings of the subjects were no statistical significance among the groups. The incidence of CBD stones was 27.3% (88 of 322) of the patients; 25.3% (66 of 261) of Group 1, 21.7% (5 of 23) of Group 2, 47.2% (17 of 36) of Group 3, and were significantly higher in Group 3 than Group 1 & Group 3 (p=0.038). However, the incidence of GB stones and cystic duct stones was no statistical significance among the groups. Malignant diseases of the biliary trees were 9.65% (31 of 322) of the patients; 6.8% (18 of 261) of Group 1, 26% (6 of 23) of Group 2, 13.8% (5 of 36) of Group 3, and were closely correlated with AUPBD (p<0.001) and LJCD (p=0.017). CONCLUSIONS: LJCD is relatively common in patients undergoing ERCP and closely correlated with the CBD stones and the malignacies of the biliary system. However its role in these condition is uncertain and needs to be further investigated.