Management of common bile duct stones in a tertiary care hospital

Abstract

Background: Common bile duct (CBD) stone is a relatively frequent disorder in our clinical practice. Early diagnosis and prompt treatment are the most important for managing CBD stones. The various modalities of treatments in bile duct stones include open, endoscopic, and laparoscopic approaches. Aim and Objectives: CBD stones are one of the common diseases faced by both surgeons and gastroenterologists. Many patients remain asymptomatic and show mild-to-moderate dyspeptic symptoms. However, symptomatic patients are frequently associated with complications that cause a lot of suffering to the patients. At present, open, endoscopic, and laparoscopic approaches are available for the management of bile duct stones with surgical methods slowly giving a way to other two newer modalities. However, treatment modalities should be individualized. The objectives of the study are various modalities of treatments in bile duct stones and the efficacy of these modalities in terms of outcomes, morbidity, and mortality. Materials and Methods: This was a prospective study of 68 patients who were admitted to Peerless Hospital and B.K. Roy Research Center between October 2014 and December 2015. Results: In this study, CBD stones were common in females between 55 and 64 years of age group. The presentation of the disease ranged from asymptomatic to symptomatic with features of complications in the form of acute biliary pancreatitis and cholangitis. Pain was the leading symptom, followed by jaundice and fever. Transabdominal USG revealed stones in bile ducts in 41.2% of cases, and the diagnosis was suspected in 26.4% of cases by only seeing proximal dilated bile ducts. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) stone extraction procedure, and in cases where the endoscopic procedure failed, open CBD exploration was done. The success rate of open surgery is marginally high than that of endoscopic intervention. Choledochoduodenostomy was performed in one patient where the open procedure failed to extract all the stones from the bile ducts. Complications seen in ERCP are pancreatitis (4.4%), hemorrhage (2.9%), cholangitis (1.5%), and death in 1 (1.5%) patient, following a severe attack of pancreatitis. Conclusion: From the above study, it is clear that open surgery is more successful than endoscopic procedure. ERCP failed due to multiple large stones and its impaction at the lower end of CBD. Hence, the patients should be categorized properly after a pre-operative workup. Facilities for the procedure and availability of experienced doctors are also crucial in making the decision.