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

الملخص EN

In this study, 70 cases of choledocholithiasis were included from general surgery department, Assuit university hospital and Kasr El-Eni university hospital and managed randomly by either conventional surgical techniques, endoscopic techniques, or laparoscopic techniques.

Ages of our patients ranged from 20-60 years (mean 40 years), with slight female predominance (female to male = 1.6: I).

Most of them presented with calcular obstructive jaundice (54.3%), however other presentations have been also encountered as colic, cholangitis, or accidental discovery in 14.3, 10, 21.5% respectively.

Group I (Surgery) included 30 patients (42.9%) who were treated by open choledocholithotomy and Ttube insertion, the mean operative time was 90 (60-180) min.

with success rate of the attempted procedures reaching 100%, and CBD clearance of stones was achieved in 96% of cases.

Hospital stay was 8 (5-12) days, with no mortality.

Morbidity rate reached 13% and was in the form of wound infection, bile leak, missed stone, and CBD stricture with jaundice.

The patient could return to work after 2 weeks (12-20 days).

Group II (Endoscopy) included 30 cases (42.9%) treated by endoscopic sphincterotomy and basket extraction in 46%, balloon in 26.6%, combined maneuver in 16.6%, mechanical lithotrepsy in 13.3%, with failure of the technique in one case (3.3%).

The mean procedure time was about 30 (20-45) min.

with success rate of attempted procedure 96.7% and CBD clearance of stones was achieved by 100%, with no mortality.

Morbidity rate of 10% was in the form of cholangitis (3.3%) and hyperamylasemia (6.6%).

The period of hospital stay was 1 (1-2) days, and patient returned to work after 4 (3-5) days.

Group 111 (Laparoscopy) included 10 cases (14.2%) treated by laparoscopic approaches in the form of trans-cystic approaches in 2 cases, trans-choledochotomy approaches in 3 cases, choledochoscopy techniques in 2 cases, and converted to open techniques with failure of the attempt in 3 cases.

The time needed for this procedure was 123 (70-292) min.

with success rate about 70%, but CBD clearance of stones reaches 100%, with no mortality.

Morbidity rate was about 20% and was in the form of hypothermia and hyperamylasemia.

The period of hospital stay was 3.2 (2-4) days with return to the work after 12 (5-15) days.