PRIMARY CLOSURE OF CBD WITH ANTEGRADE STENTING FOR CHOLEDOCHOLITHIASIS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 48
Abstract
BACKGROUND Traditional teaching has been to close the Common Bile Duct (CBD) over a T-tube after exploration for stone disease. With the advent of ERCP and medical grade biliary stents, the art of T-tube placement seems to be on the wane. We aim to present our experience of primary closure of the CBD with antegrade stenting after CBD exploration. MATERIALS AND METHODS A retrospective descriptive study (Audit) was performed from the operating room database of our hospital for those patients who underwent primary closure of the CBD with antegrade stenting (Both Laparoscopic and Open) during the period of 2007 - 2015. A systematic record review with review of the OT notes with special emphasis on intraoperative findings and post-procedural complications was carried out. RESULTS The study period saw a total of 88 patients being operated; 65 in Group 1 (Antegrade stenting) and 23 in Group 2 (T tube). Most frequent presenting complaint was obstructive pattern of jaundice followed by right upper quadrant pain, fever and a combination in both the study groups. A total of 39 (60%) females and 26 (40%) males underwent surgery in Group 1 (Range 18 – 75 years, Mean 37 years). The average operative duration in the open CBDE was 146 mins, whereas the LCBDE arm had a mean duration of 186 mins. The mean hospital stay was 3 days for LCBDE patients (Range 2 - 4) and 5 days for OCBDE patients (Range 3 - 7). No patients in the study Group 1 required re-intervention or repeated imaging. Patients were aged between 26 and 75 years with a median age of 50 years in Group 2 with 9 males and 12 females. The mean operative time in T-tube group (Group 2) was 113.26 ± 21.62 mins. T-tube cholangiogram was carried out on POD-14 as a protocol before removal of T-tube. CONCLUSION CBDE with antegrade stent placement is an attractive alternative to T-tube placement in patients undergoing CBDE. The morbidity associated with T-tube and the need for TTC is avoided, hence enabling a faster recovery and return to work interval in such patient cohort.
Authors and Affiliations
Nagesh Nayakarahalli Swamygowda, Balakrishna Nanjundappa Setty, Sridhara Kolala Govindaiah, Kaushik Subramanian, Venugopal Hunasanahalli Giriyappa, Vinay Boppasamudra Nanjegowda, Savitha Krishna Gowda Karlwad
Keywords
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- EP ID EP218679
- DOI 10.14260/Jemds/2017/795
- Views 95
- Downloads 0
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