Management and outcome of residual bile duct stones following cholecystectomy at a tertiary referral centre in Sri Lanka.

ABSTRACT

BACKGROUND: In spite of the advent of pre- and per-operative imaging techniques, the problem of residual bile duct stones following laparoscopic or open cholecystectomy still exists with a reported frequency of 2-10%. Endoscopic stone extraction is a minimally invasive technique which is fast becoming popular in the management of residual ductal stones. OBJECTIVE: To review the experience in our unit with regard to clinical presentation and the outcome following endoscopic management of residual bile duct stones. DESIGN: Retrospective descriptive study. SETTING: Patients referred to a tertiary referral centre with suspected residual bile duct stones following open or laparoscopic cholecystectomy from 5 March 2002 to 31 December 2006. PATIENTS AND METHOD: 56 patients with suspected residual bile duct stones were reviewed with regard to clinical presentation, stone profile, success rate and outcome. RESULTS: Mean age of the sample was 43.2 years. Female to male ratio was 34/22. 4 (73.3%). Main presenting symptom was epigastric or right hypochondrial pain (39.2%). Presence of residual stones or gravel noted in 91% (51) during ERCP. Complete stone extraction was achieved in 83.9% (47). All these patients became completely asymptomatic. Four patients had ERCP related morbidity. There were no deaths. Longest follow up was 38 months and the shortest 1.5 months. CONCLUSIONS: Endoscopic approach is a safe and effective method in the diagnosis and treatment of residual bile duct stones.