MANAGEMENT OUTCOME OF RESIDUAL COMMON BILE DUCT STONES AT AGA KHAN UNIVERSITY HOSPITAL
Abstract
Background: The frequency of residual common bile duct (CBD) stones in patients with previouscholecystectomy ranges from 2-10%, and a minimally invasive approach is generallyrecommended for these patients. This study reviews the experience in the management of residualCBD stones at the Aga Khan University Hospital. Methods: All adult patients diagnosed to haveresidual CBD stones, from 1993 to 2001, were identified and analyzed in terms of the treatmentmodality utilized and its associated complications. The role of endoscopic sphincterotomy wasparticularly analyzed in our set-up. Results: The study population consisted of 66 patients. Themean age was 52 (range:18-84 years) years with a female to male ratio of 51:15. The primarymode of management consisted of endoscopic sphincterotomy in 61 patients (92.5%). The initialclearance rate for these patients was 75%, while the remaining 25% required ancillary proceduresto achieve a complete clearance. Procedure related complications were observed in 17 (28%)patients, with zero mortality. The other 5 patients (7.5%) underwent an open choledochotomy as aprimary procedure with no further complications. Conclusions: Endoscopic sphincterotomy is themost frequent treatment modality used for the management of residual CBD stones at our hospital.Although initial success rate seems low, the fact that endoscopic sphincterotomy is a less invasiveprocedure justifies its preferential utilization. The study does not compare the results ofendoscopic management with open surgery, as the number of patients managed by opencholedochotomy is very small.Keywords: Common bile dust stones, Retained common bile duct stones, Endoscopicsphincterotomy, Endoscopic retrograde cholangiopancreaticographyReferences
Pitt AH. Role of Choledochotomy in the Treatment of
Choledocholithiasis. Am J Surg 1993;170:483-6.
Stain SC, Cohen H, Tsuishoysha M, Donovan AJ.
Choledocholithiasis: Endoscopic Sphincterotomy or
Common Bile Duct Exploration. Ann Surg 1991;213:627-34.
Nauhaus H. Prospective Evaluation of the use of endoscopic
retrograde cholangiography prior to laparoscopic
cholecystectomy. Endoscopy 1992;24(9):745-9.
Ludwig K, Bernhardt J, Steffen H, Lorenz D. Contribution of
intraoperative cholangiography to incidence and outcome of
common bile duct injuries during laparoscopic
cholecystectomy. Surg Endosc 2002;16(7):1098-1104.
Flum DR, Koepsell T, Heagerty P, Sinanan M, Dellinger EP.
Common bile duct injury during laparoscopic
cholecystectomy and the use of intraoperative
cholangiography: adverse outcome or preventable error?
Arch Surg 2001;136(11):1287-92.
Thornton DJ, Robertson A, Alexander DJ. Laparoscopic
cholecystectomy without routine intraoperative
cholangiography does not result in significant problems
related to retained stones. Surg Endosc 2002;16(4):592-5.
Neuhaus G. Prospective evaluation of the use of endoscopic
retrograde cholangiography prior to laparoscopic
cholecystectomy. Endoscopy 1992;24:745-9.
Graham SM. Laparoscopic cholecystectomy and common
bile duct stones. Ann Surg 1993;218:61-7.
Braghetto I, Debandi A, Korn O, Bastias J. Long-term follow
up after laparoscopic cholecystectomy without routine
intraoperative cholangiography. Surg Laparosc Endosc
;8(5):349-52.
Vezakis A, Davides D, Ammori B, Martin IG, Larvin M,
McMahon MJ. Intraoperative cholangiography during
J Ayub Med Coll Abbottabad 2005;17(3)
laparoscopic cholecystectomy. Surg Endosc
;14(12):1118-22.
Csendes A. World progress in Surgery: Common bile duct
stones – Introduction. World J Surg 1998;22(11):1113.
Schmitt CM, Baillie J, Cotton PB. ERCP following
laparoscopic cholecystectomy: A safe and effective way to
manage CBD stones and complications. HPB Surgery
;8:187-92.
Fiore NF, Ledniczky G, Wiebke EA, Broadie TA, Pruitt Al,
Goulet RJ et al. An analysis of perioperative cholangiography
in one thousand laparoscopic cholecystectomies. Surgery
;122:817-23.
Rosenthal RJ, Rossi RL, Martin RF. Options and strategies
for the management of choledocholithiasis. World J Surg
;22:1125-32.
Jafri SMW. Approach to the difficult common bile duct
stone. Pakistan J Gastroenterol 1995;9(2):11-4.
Phillips EH, Rosenthal RJ, Carroll BJ, Fallas MJ.
Laparoscopic transcystic common bile duct exploration. Surg
Endosc 1994;8:1389-94.
Kapoor R, Pradeep R, Sikora SS, Saxena R, Kapoor VK,
Kaushik SP. Appraisal of surgical and endoscopic
management of choledocholithiasis. Aust N Z J Surg
;64(9):599-603.
Johnson AS, Ferrara JJ, Steinberg SM, Gassen GM, Hollier
LH, Flint LM. The role of endoscopic retrograde
cholangiopancreaticography: sphincterotomy versus common
bile duct exploration as a primary technique in the
management of choledocholithiasis. Am Surg 1993;59(2):78-
Suc B, Escat J, Cherqui D, Fourtanier G, Hay JM, Fingerhut
A, et al. Surgery vs endoscopy as primary treatment in
symptomatic patients with suspected common bile duct
stones: a multicenter randomized trial. French Association
for Surgical Research. Arch Surg 1998;133(7):702-8.
Kharrat J, Kchaou-Ouakaa A, Bel-Hadj N, Gargouri D,
Kochlef A, Romani M, et al. Endoscopic treatment of
residual lithiasis. 661 cases. Tunis Med 2005;83(1):13-7.
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