HP17 COMMON BILE DUCT STONES: A REVIEW OF MANAGEMENT OPTIONS

Abstract

Purpose Two recent meta‐analyses support operative CBD exploration (laparoscopic or open) as at least equal to ERCP for the management of choledocholithiasis with the gall bladder in situ. The literature regarding laparoscopic exploration is largely from enthusiasts and may not be transferable across institutions. In our institution both hepatobiliary and general surgeons perform cholecystectomy with variable comfort levels with laparoscopic CBD exploration. ERCP and laparoscopic antegrade transampullary biliary stents are available. We review the management of choledocholithiasis in this setting.Methods A retrospective review of all patients who underwent cholecystectomy during 2004 and 2005 at two Newcastle hospitals was conducted.Results The incidence of choledocholithiasis was 10.3% (70 patients). This was diagnosed pre‐operatively in 36 patients; 22 underwent pre‐operative ERCP (62.5% clearance) and 14 operative CBD exploration (100% clearance). An additional 22 patients with presumed choledocholithiasis had a normal cholangiogram at pre‐operative ERCP. Operative cholangiogram first confirmed choledocholithiasis in 31 patients; CBD exploration was successful in 58.8% (10 of 17). Intra‐operative biliary stents were inserted in 15 patients due to a small calibre CBD, failed exploration or lack of equipment and time for exploration. Hepatobiliary surgeons more frequently performed operative CBD exploration and stent placement.Conclusion The management of choledocholithiasis varies with the clinical scenario and local expertise. This series defines a role for intra‐operative stent placement, suggests pre‐operative ERCP is over‐utilised, and that operative CBD exploration is successful with low morbidity.