Surgical morbidity and mortality in patients with calculus biliary tract diseases

Zubair Afzal Khan


Background: In the era of laparoscopic cholecystectomy the discussion on morbidity and mortality of open cholecystectomy still holds importance and should not be considered obsolete. The values of good anaesthesia, good muscular relaxation, adequate operative exposure and adequate stretch on the CBD and careful anatomical dissection are very well known. The objective of the study was to study the surgical morbidity and mortality in patients with calculus biliary tract diseases.

Methods: The study included 839 patients with surgical jaundice and various surgical modalities applied as per the need and indication. 168 patients out of 839 were referred to Department of General Surgery for surgical management.

Results: The commonest surgical procedure carried out was cholecystectomy with CBD exploration in 102 (60.71%) patients. Only CBD stone was found in 79 (47.02%) patients. Total 43 (25.60%) incidence of post-operative complications were reported in the patients. Surgical wound infection (20, 11.90%) was the commonest post-operative complications, followed by chest infection              (13, 7.74), and biliary leakage (4, 2.38%). Four (2.38%) deaths were reported among 168 cases.

Conclusions: Conventional surgeries like CBD exploration, choledochoduodenostomy (CDD), choledochoju-jenostomy (CDJ), transduodenal sphincteroplasty (TDS) can be associated with morbidity and mortality in spite of optimisation and excellent postoperative care.


Biliary tract diseases, Cholelithiasis, Surgical approach, Complications

Full Text:



Holzheimer RG. Cholecystitis and Cholelithiasis. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available at: Accessed on 12 December 2018.

Kelley WE Jr. The evolution of laparoscopy and the revolution in surgery in the decade of the 1990s. JSLS. 2008;12(4):351–7.

Blum CA, Adams DB. Who did the first laparoscopic cholecystectomy? J Minim Access Surg. 2011;7(3):165–8.

Comitalo JB. Laparoscopic cholecystectomy and newer techniques of gallbladder removal. JSLS. 2012;16(3):406–12.

Kaushal-Deep SM, Singh V, Mani R, Gupta P, Lodi M. Negotiating the Curve of Laparoscopic Hepatopancreaticobiliary Procedures (Basic to Advanced) at a Tertiary Rural Teaching Institute. Int J Appl Basic Med Res. 2018;8(4):237-43.

Novello M, Gori D, Di Saverio S, Bianchin M, Maestri L, Mandarino FV, et al. How Safe is Performing Cholecystectomy in the Oldest Old? A 15-year Retrospective Study from a Single Institution. World J Surg. 2018;42(1):73-81.

Costi R, Gnocchi A, Di Mario F, Sarli L. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol. 2014;20(37):13382–401.

Tiong L, Oh J. Safety and efficacy of a laparoscopic cholecystectomy in the morbid and super obese patients. HPB (Oxford). 2015;17(7):600–4.

Halbert C, Pagkratis S, Yang J, Meng Z, Altieri MS, Parikh P, et al. Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc. 2016;30(6):2239-43.

Liu CL, Fan ST, Lai EC, Lo CM, Chu KM. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg. 1996;131(1):98-101.

Jones MW, Deppen JG. Open Cholecystectomy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019. Available at: https://www.ncbi. Accessed on 27 February 2019.

Girard RM, Morin M. Open cholecystectomy: its morbidity and mortality as a reference standard. Can J Surg. 1993;36(1):75-80.

Mathew G, King KC. Gallbladder, Empyema.. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019. Available at: https://www.ncbi. Accessed on February 27, 2019.

Nagle A, Soper NJ, Hines JR. Cholecystectomy (Open and laparoscopic) In: Zinner MJ, Ashley SW, editors. Maingot's Abdominal operations. 11th edition. Mc Graw Hill; New York: 2006.

Abboud PA, Malet PF, Berlin JA, Staroscik R, Cabana MD, Clarke JR, et al. Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. Gastrointest Endosc. 1996;44:450–5.

Fulcher AS. MRCP and ERCP in the diagnosis of bile duct stones. Gastrointest Endosc. 2002;56(Suppl 6):S178–S182.

Liu TH, Consorti ET, Kawashima A, Tamm EP, Kwong KL, Gill BS. Patient evaluation and management with selective use of magnetic resonance cholangiography and ERCP before laparoscopic cholecystectomy. Ann Surg. 2001;234:33–40.

Chrungoo RK, Choudhary NH, Kariholu PL, Pathak BSN, Kapoor KL. Factors affecting morbidity in biliary tract surgery. Indian J Surg. 1990;52:63-8.

Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc. 2002;56(6):165–9.

Hai A, Singh A. Operative on the common bile duct. Indian J Surg. 1985;31:326-80.

Meyer KA, Capos NJ, Mittelpunkt AI. Personal experience with 1261 cases of acute and chronic cholecystitis and cholelithiasis. Surgery. 1967;61:661-8.

Wani NA, Lawerence MB, Shah IA, Fazill F. Management of residual bite duct calculi: Experience with saline irrigation. Ind J Surg. 1987;33:462-6.

Daniel SL, Eggleston FC. Choledochoduo-denostomy - Experience in 44 patients. Indian J Surg. 1978;24:423-5.

Margiotta KK, Horwitz JR, Wills IH, Willack M. Cholecystectomy in the elderly. Am J Surg. 1988;156:509-12.

Giovanni C, Watters CS, Rossitch JC, Meyers WC. Deaths from Gall stones - Incidence and associated clinical factors. Ann Surg. 1989;209:149-51.

Colcock BP, Perey B. Treatment of Choleclithiasis. Surg Gynecol Obstetr. 1963;117:529-34.