DOI: http://dx.doi.org/10.18203/2349-2902.isj20220321

Surgical management of choledocholithiasis: a single institutional experience

Dinakar Reddy Annareddy, Anuroop Thota

Abstract


Background: Choledocholithiasis is the 2nd most common complication of gallbladder stone disease and its incidence increases with age. There are different modalities of treatment ranging from endoscopic techniques to open and minimally invasive surgery. However, the single best modality has remained a point of major speculation. This study was undertaken to evaluate various modalities of surgical treatments undertaken at our institute.

Methods: A retrospective analysis of all the patients who underwent surgery for common bile duct stones during the study period was done. The parameters analyzed were epidemiological data, clinical parameters, surgical details and any complications.

Results: A total of 50 patients were included in the study with a M:F ratio of 1:1. The most common presenting complaint was pain abdomen and the majority, were post ERCP failure cases. The common cause for failure was multiple or impacted stones. Majority of the patients underwent an open surgery and a drainage procedure in the form of choledochoduodenostomy was added. Laparoscopic exploration showed advantage in form of shorter hospital stay, early return to activity. There were no instances of retained or missed stones and the complications were limited to wound complications.

Conclusions: In the era of advanced endoscopy, surgery still holds an eminent place in the management of choledocholithiasis. With growing expertise, the complication and clearance rates are better than endoscopy. Laparoscopic exploration can be the single best treatment for patients with both cholelithiasis and choledocholithiasis.


Keywords


Cholelithiasis, Choledocholithiasis, Endoscopic retrograde cholangiopancreaticogram, Laparoscopic surgery, Choledochotomy

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References


Jinfeng Z, Yin Y, Chi Z, Junye G. Management of impacted common bile duct stones during a laparoscopic procedure: a retrospective COHORT study of 377 consecutive patients. Int J Surg. 2016;32:1-5.

Tarantino G, Magistri P, Ballarin R, Assirati G, Cataldo AD, Benedetto FD. Surgery in biliary lithiasis: from the traditional “open” approach to laparoscopy and the “rendezvous” technique. Hepatobil Pancreat Dis Int. 2017;16(6):595-601.

Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg. 2004;239(1):28-33.

Treckmann J, Sauerland S, Frilling A, Paul A. Common bile duct stones-update 2006. In: Neugebauer EAM, Sauerland S, Fingerhut A, Millat B, Buess G, eds. EAES guidelines for endoscopic surgery. Berlin, Heidelberg: Springer; 2006: 329-33.

Hungness ES, Soper NJ. Management of common bile duct stones. J Gastrointest Surg. 2006;10(4):612-9.

Verbesey JE, Birkett DH. Common bile duct exploration for choledocholithiasis. Surg Clin. 2008;88:1315-28.

Tekin A, Ogetman Z. Laparoscopic exploration of the common bile duct with a rigid scope in patients with problematic choledocholithiasis. World J Surg. 2010;34(4):1894-9.

Martin JA. Endoscopic retrograde cholangiopancreatography in the management of bile duct stones. Tech Gastrointest Endosc. 2012;14(1):156-63.

Gad EH, Zakariaa H, Kamel Y, Alsebaey A, Zakareya T, Abbasyc M, et al. Surgical (open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: a retrospective COHORT study. Ann Med Surg. 2019;43:52-63.

Schreurs WH, Juttmann JR, Stuifbergen WN, Oostvogel HJ, vanVroonhoven TJ. Management of common bile duct stones: selective endoscopic retrograde cholangiography and endoscopic sphincterotomy: short- and long-term results. Surg Endosc 2002;16(7):1068-72.

Martin DJ, Vernon DR, Toouli J. (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2006;19(2):003327.

Sikic N, Tutek Z, Strikic N. Primary suture vs. T-tube after common bile duct exploration (our 25 years of experience). Przegl Lek 2000;57(5):143-5.

Campagnacci R, Baldoni A, Baldarelli M, Rimini M, DeSanctis A, DiEmiddio M, et al. Is laparoscopic fiberoptic choledochoscopy for common bile duct stones a fine option or a mandatory step? Surg Endosc. 2010;24(3):547-53.

Hartery K, Lee CS, Doherty GA, Murray FE, Cullen G, Patchett SE, et al. Covered self-expanding metal stents for the management of common bile duct stones, astrointest. Endosc. 2017;85(1):181-6.

Dorman JP, Franklin ME. Laparoscopic common bile duct exploration by choledochotomy. Semin Laparosc Surg. 1997;4(1):34-41.

Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M, et al. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008;57(7):1004-2.

Shelat VG, Chia VJM, Low J. Common bile duct exploration in an elderly asian population. Int Surg. 2015;100(2):261-7.

Costi R, Gnocchi A, DiMario 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.

Pierce RA, Jonnalagadda S, Spitler JA, Tessier DJ, Liaw JM, Lall SC, et al. Incidence of residual choledocholithiasis detected by intraoperative cholangiography at the time of laparoscopic cholecystectomy in patients having undergone preoperative ERCP. Surg Endosc. 2008;22(11):236-72.

Puhalla H, Flint N, O’Rourke N. Surgery for common bile duct stones-a lost surgical skill; still worthwile in the minimally invasive century? Langenbecks Arch Surg. 2015;400(1):119-27.

Brown LM, Rogers SJ, Cello JP, Brasel KJ, Inadomi JM. Cost-effective treatment of patients with symptomatic cholelithiasis and possible common bile duct stones. J Am Coll Surg. 2011;212(6):1049-60.

Lee HM, Min SK, Lee HK. Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis: 15-year experience from a single center. Ann Surg Treat Res. 2014;86(1):1-6.

Sawyers JL, Herrington JL, Edwards WH. Primary closure of the common bile duct. Am J Surg. 1965;109(5):107.

Guruswamy KS, Samraj K. Primary closure versus T-tube drainage after laparoscopic common bile duct exploration. Cochrane Database Syst Rev. 2007;1:005641.

Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2013;2013(12):003327.

Hua J, Lin S, Qian D, He Z, Zhang T, Song Z. Primary closure and rate of bile leak following laparoscopic bile duct exploration via choledochotomy. Dig Surg. 2015;32(1):1-8.

Csendes A, Csendes P, Burdiles P, Diaz JC, Maluenda F, Burgos AM. Behavior of the common bile duct diameter before and 12 years after choledochostomy for cholecystolithiasis and choledocholithiasis. A prospective study. J Gastrointest Surg. 2007;11(10):1294-7.

Tranter SE, Thompson MH. Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct. Br J Surg. 2002;89(12):1495-504.

NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. NIH Consens State Sci Statements. 2002;19(1):1-23.

Williams E, Beckingham I, ElSayed G, Gurusamy K, Sturgess R, Webster G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut. 2017;66(5):765-82.