Author/Authors :
Shojaiefard, Abolfazl tehran university of medical sciences tums - Shariati Hospital - Department of Surgery and Research Center for Improvment of Surgical Out comes and Procedures, تهران, ايران , Esmaeilzadeh, Majid University of Heidelberg - Department of General, Visceral and Transplantation Surgery, Germany , Khorgami, Zhamak tehran university of medical sciences tums - Shariati Hospital - Department of Surgery and Research Center for Improvment of Surgical Out comes and Procedures, تهران, ايران , Sotoudehmanesh, Rasoul tehran university of medical sciences tums - Shariati Hospital - Digestive Diseases Research Center, تهران, ايران , Ghafouri, Ali tehran university of medical sciences tums - Shariati Hospital - Department of Surgery and Research Center for Improvment of Surgical Out comes and Procedures, تهران, ايران
Abstract :
Background: Choledocholithiasis exists in approximately 15% of patients with gallstones and is present in 3%-10% of those undergoing cholecystectomy. Methods: In this study, we retrospectively analyzed the outcome patients with choledocholithiasis that were managed by open common bile duct (CBD) exploration according to our center s protocol. Endoscopic retrograde cholangiopancreatography (ERCP) was performed for CBD stone clearance. If ERCP and sphincterotomy were not successful, open surgical exploration of CBD was performed with T-tube inser- tion without routine intraoperative cholangiography (IOC). Results: We studied 1462 patients with choledocholithiasis. ERCP was successful in in 1276 (87.2%) patients. A total of 186 (12.8%) underwent surgery. Of these, 82 (45.2%) had CBD exploration and T-tube insertion without IOC. Choledochoduodenostomy was performed in 82 (44.1%) patients and choledochojejunostomy was performed in 20 (10.8%). Retained stones were found only in 4 cases which were treated by ERCP. Conclusion: ERCP is successful in most cases with choledocholithiasis. If ERCP fails, open exploration of CBD and T-tube insertion, or biliary-enteric anastomosis are acceptable ways for CBD drainage. The rate of retained stone is not more than expected, thus elective IOC is more acceptable than routine IOC. Routine IOC is time-consuming and particularly difficult in elderly patients and emergency conditions.
Keywords :
Choledochoduodenostomy , Choledochojejunostomy , Choledocholithiasis , ERCP
