Management and outcome of residual bile duct stones following cholecystectomy at a tertiary referral centre in Sri Lanka

Abstract

In spite of the advent of pre- and per-operative imaging techniques, the problem of residual bile duct stones following laparoscopic or open cholecystectomy still exists with a reported frequency of 2-10%. Endoscopic stone extraction is a minimally invasive technique which is fast becoming popular in the management of residual ductal stones. To review the experience in our unit with regard to clinical presentation and the outcome following endoscopic management of residual bile duct stones. Retrospective descriptive study. Patients referred to a tertiary referral centre with suspected residual bile duct stones following open or laparoscopic cholecystectomy from 5 March 2002 to 31 December 2006. 56 patients with suspected residual bile duct stones were reviewed with regard to clinical presentation, stone profile, success rate and outcome. Mean age of the sample was 43.2 years. Female to male ratio was 34/22. 4 (73.3%). Main presenting symptom was epigastric or right hypochondrial pain (39.2%). Presence of residual stones or gravel noted in 91% (51) during ERCP. Complete stone extraction was achieved in 83.9% (47). All these patients became completely asymptomatic. Four patients had ERCP related morbidity. There were no deaths. Longest follow up was 38 months and the shortest 1.5 months. Endoscopic approach is a safe and effective method in the diagnosis and treatment of residual bile duct stones.