Volume : III, Issue : VII, July - 2014

Management of Common Bile Duct Stones

Hitendra K. Desai, Alpesh J. Patel

Abstract :

Objective: Common bile duct (CBD) calculi usually occur as a complication of gall bladder calculi. However, left untreated, they cause significant morbidity. Multiple treatment modalities have been developed over the year to treat CBD stones. However, a consensus on the best method for stone removal has not yet been reached. The present study was carried out to study and compare two modalities of treatment, namely open surgery and ERCP in items of efficacy and safety. Methods: This is a prospective study of management of 40 cases of CBD stones. Of these, 20 were managed by open surgery while the other 20 were managed by ERCP. Each patient was carefully evaluated and analysed according to the data collected on a planned proforma prepared for the study. Results: Out of 40 cases of CBD stones, 20 were managed by open surgery while other 20 were managed by ERCP. Out of 20 open surgery, 15 underwent CDD while 5 underwent CDL with T-tube placement. In ERCP group, 19 patients had EBS with Dormia basketing and stenting while in 1 patient, cannulation was not possible. All patients were followed up immediately post procedure, at 15 days and at 30 days for clinical assessment and laboratory parameters. On follow up, regression of symptoms and laboratory parameters was seen in 19 patients in open surgery group and in 16 patients in ERCP group. The incidence of duct clearance was 95% in open surgery and 80% in ERCP. The incidence of duct clearance in open surgery for large stones was 100% while in ERCP was 75%. The incidence of duct clearance in open surgery for small stones was 86% while in ERCP was 100%. An additional procedure was required in 5 % of patients who underwent open surgery as compared to 20% of patients who underwent ERCP. The incidence of major morbidity was 20% in open surgery while it was 15% in ERCP. The incidence of minor morbidity was 30% in open surgery while it was 60% in ERCP. The incidence of mortality was 5% in open surgery and 0 % in ERCP. Conclusion: Open surgery is more efficacious than ERCP in terms of achievement of common bile duct clearance for common bile duct calculi. For the optimum management of CBD stones, stone size should be taken into consideration. Open surgery is better than ERCP in terms of achievement of common bile duct clearance for large ( size > 1 cm ) common bile duct calculi. ERCP is better than open surgery in terms of achievement of common bile duct clearance for small ( size < 1 cm ) common bile duct calculi. Open surgery is more efficacious than ERCP in terms of achievement of regression of symptoms, signs and biochemical parameters for common bile duct calculi. Open surgery is safer than ERCP in terms of incidence of minor morbidity. Open surgery and ERCP are comparable in terms of major morbidity. ERCP is safer than open surgery in terms of incidence of mortality. The use of ERCP necessitates increased number of procedures per patient.

Keywords :

Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Hitendra K. Desai, Dr Alpesh J. Patel Management of Common Bile Duct Stones International Journal of Scientific Research, Vol : 3, Issue : 7 July 2014

Number of Downloads : 1254

References :