Surgical management of choledocholithiasis:Al-Mouasat University Hospital experience in Damascus

Abstract

Background: Cholelithiasis is one of the most common diseases of the digestive system in various parts of the world. Its incidence increases with age. The presence of stones in the common bile duct is associated with cholelithiasis in 20% of cases, as it is considered the second most common complication of gallstone disease and is asymptomatic in approximately half of the cases. Treatment methods range from endoscopic techniques to open and laparoscopic surgery. However, the single best modality has remained a point of major speculation. This study was conducted to evaluate various methods of surgical treatments performed in our hospital.

Methods: The study was performed in a retrospective analysis method for all patients who underwent surgery for common bile duct stones during the study period. The information analyzed was patient data, clinical manifestations, surgical details and complications.

Results: A total of 21 patients were included in the study with a male-to-female ratio of 2:1. The most common complaint was abdominal pain, the majority of cases due to ERCP failure. The common cause of failure was multiple or impacted stones. Majority of patients underwent open surgery with the addition of biliary drainage in the form of CDD. On the other hand, laparoscopic intervention showed an advantage in shortening the length of hospital stay and early return to daily activities. There were no cases of residual or forgotten stones and complications were limited to wound complications.

Conclusions: In the era of advanced endoscopy, surgery still occupies a prominent place in the management of cholelithiasis. With increasing experience, complication rates and clearing of the bile duct from stones are considered better than laparoscopy. Laparoscopic surgery can be chosen as a single treatment option for patients who suffer from both gallstones and CBD stones.

Keywords: cholelithiasis, CBD stones, Laparoscopic exploration of the CBD, open exploration of the CBD