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

ABSTRACT

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