A Prospective Study on Endoscopic Versus Surgical Management of Choledocholithiasis
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 5
Abstract
Introduction: Choledocholithiasis is the most common cause of obstructive jaundice and occurs in about 10% of patients with symptomatic gallstone. The need for subsequent cholecystectomy in patients with gall bladder in situ after endoscopic removal of stones from the common bile duct is controversial. Methodology: A prospective study was conducted from November 2014 to march 2016 in patients diagnosed to have Choledocholithiasis . Patients with intra hepatic stones and biliary stricture were excluded from the study. A total of 35 with a diagnosis of Choledocholithiasis were included in this study. Results: There was a slightly increased incidence in male patients (M:F 1:0.94). Pain abdomen, jaundice and fever are the common clinical symptom, Serum bilirubin and alkaline phosphates levels were usually deranged. Ultrasonography has 70.9% sensitivity. MRCP and CT done only in patients ultrasonography was negative. ERCP with ES had a success rate of 86.36%. Cholecystectomy was done in 9(4.36%) patients after ERCP. 12(38.7%) patients underwent open surgical procedures. Escherichia coli and klebsialla spp the most common organisms isolated. Complications were more common in patients whom underwent open surgery. Mean hospital stay in endoscopic interventions was 11.84 days. Patients who underwent open surgery had more prolonged hospital stay with a mean of 26-67 days. Conclusion: Ultrasonography has a sensitivity of 70.96% in detecting calculi. Routine se of MRCP and CT is not required. ERCP with ES can be used as the only intervention for the treatment of CBD calculi in patients with a normal gall bladder. Cholecystectomy needs to be done only in patients with gall bladder pathology. Complications are more in patients whom undergo open surgery. There is a significant decreased mean hospital stay in patients who undergo endoscopic treatment.
Authors and Affiliations
Dr. P. V. Durga Rani, Dr. Chanda Ramana Chalam, Dr. T Prasad, Dr. K. Appa Rao
Keywords
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- EP ID EP597045
- DOI 10.9790/0853-1605034753.
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