Common bile duct clearance of stones by surgery, endoscopy and laparoscopy [comparative study]

In this study, 70 cases of choledocholithiasis were managed randomly by either conventional surgical techniques, endoscopic techniques or laparoscopic techniques. Most of these patients were presented with calcular obstructive jaundice [54.3%]; however other presentations were also encountered as colic, cholangitis or accidental discovery in 14.3%, 10% and 21.5%, respectively. Group I [surgery] included 30 patients who were treated by open choledocholithotomy and T tube insertion, the mean operative time was 90 [60-180] min. Group II [endoscopy] included 30 cases treated by endoscopic sphincterotomy and basket extraction in 46%, balloon in 26.6%, combined maneuver in 16.6% and mechanical lithotripsy in 13.3%. Group III [laparoscopy] included ten cases treated by laparoscopic approaches in the form of trans- cystic approaches in two cases, trans-choledochotomy approaches in three cases, choledochoscopic techniques in two cases and converted to open techniques with failure of the attempt in three cases. The study showed that open surgery permits direct manual palpation and instrumentation of bile ducts using a variety of instruments. However, it has its drawbacks in long maneuver time, invasiveness, increased mortality and morbidity, long hospital stay and delayed return to work. On the contrary, endoscopic management of choledocholithiasis has the advantage of minimally invasive maneuver, could be done as outpatient clinic, less procedure time, less hospital stay, very low or no mortality and morbidity, rapid return of the patients to work

Comparative study of the different procedures for management and prevention of post. E.R.C.P. infective complication

Selected 240 cases with obstructive jaundice. 120 cases calcular obstruction and 120 cases with malignant obstruction were studied of idenfication of the main causes of post E.R.C.P. infective complications. The clinical, laboratory and endoscopic findings are discussed. It was found that the most important infective complications after E.R.C.B are biliary bacteremia, cholangitis, pancreatitis and septicemia, and the most important predisposing factors for these complications are inadequate instruments sterilization, calcular biliary obstruction or stricture, incomplete drainage of the biliary channels, the occurrence of mucosal lesions during the procedure, or overfilling of the biliary channels during the procedure and any cause of decreased patient immunity. It was found that intravenous injection of a suitable antibiotic gives the best results for prevention and control of these complications rather than the intraductal injection or washing only without antibiotic, Somatostatin proved to he of no benefit in that respect in our study. Thus we recommend T.V injection of a suitable antibiotics in these cases