Transduodenal sphincteroplasty versus choledochoduodenostomy in management of lower common bile duct stones

Abstract EN

Common bile ducts stones have been noted in 10-15% of patients with gall stones, these stones are either primary (formed in the common bile duct) or secondary (formed in the gallbladder and migrate down to the common bile duct).

Their management includes ERCP (Endoscopic Retrograde Choler ochopancreatography), biliary drainage procedure and choledochal exploration.

In this interventional study, we compare between trans duodenal sphincteroplasty and choledochoduodenostomy regarding morbidity (anastomotic and duodenal leak, cholangitis, and pancreatitis) and mortality related to each surgical option.

A review of 68 patients with lower common bile duct stones presents with different clinical presentations in an interventional study carried in Basrah General Hospital and Al–Moussawi Private Hospital, 22 patients underwent trans duodenal sphincteroplasty and, 46 patients underwent choledochoduodenostomy.

Both groups received general anesthesia and comparable in age and sex.

Statistical analysis done by SPSS (Statistical Package for Social Sciences) version 18.

Age and sex are comparable in both groups, the incidence of postoperative cholangitis is 9.09 % in the trans duodenal sphincteroplasty group and 32.6 %in choledochoduodenostomy group which is statistically significant (P value 0.01).

The incidence of duodenal and anastomotic leak is 13.6 % and 10.9 % in trans duodenal sphincteroplasty and choledochoduodenostomy group respectively which is statistically not significant (P value 0.707).

The incidence of postoperative pancreatitis is 0 % and 8.7 % in trans duodenal sphincteroplasty and choledochoduodenostomy group respectively which is statistically not significant (P value 0.296).

The mortality is 0 % after trans duodenal sphincteroplasty and 6.5 % after choledochoduodenostomy.

In conclusion, trans duodenal sphincteroplasty is better than choledochoduodenostomy in the management of lower common bile duct stones, less postoperative cholangitis, pancreatitis, and lower mortality rate.