THE EFFECT OF URSODEOXYCHOLIC ACID AS A CONSERVATIVE TREATMENT OF SECONDARY COMMON BILE DUCT STONES IN PREPARATION FOR LAPAROSCOPICAL CHOLECYSTECTOMY

Kadhim Hassan Al-Hassani

doi:10.33762/bsurg.2012.55551

Abstract

Calculus cholecystitis with secondary bile duct stones is a surgical problem that solved by many surgical/conservative options. In our study we use oral Ursodeoxycholic acid as a medical dissolution therapy for secondary common bile duct stones in preparation for cholecystectomy. The study aimed to see the effects of ursodeoxycholic acid on biliary stone dissolution in our locality. A prospective study on twenty one patients presented with calculus cholecystitis and CBD stones from January 2010 to January 2011 involved in this study, they received oral Ursodeoxycholic acid (ursogall, UDCA) in a dose of 300 mg twice daily p.o over period of four to six weeks & some of them repeat course of treatment. During the period of observation, seventeen patients respond to medical treatment showed decrease or absence of jaundice and four patients show no response. It is concluded that: This study illustrate that we can use bile acids as medical dissolution treatment in some indicated patients with CBD stones, there is a chance of conservative treatment to be a way of treating patients with obstructive jaundice due to common bile duct stones, although the number of patient is small owing to the natural occurrence of such cases all over the world and we are lacking the standard facilities of identical research equipment and the comparative differentiation between diseased patients and control cases ; our results need further research with big number of patients and more elements of investigations.

Highlights

The extra hepatic bile ducts consist of the right and left hepatic ducts, the common hepatic duct, the cystic duct, and the common bile duct or choledochus[1]
Twenty one patients were challenged to a conservative medical treatment receiving Ursodeoxycholic acid (UDCA) orally in the form of capsule 300 mg twice daily before meals over period of 4-6 weeks; some of them needed to repeat the course of treatment after partial response showing a total complete response in 17 patients with complete dissolution (81%), 2 out of 21 patients show partial responses (14.2%) and lost, one patients show no response (9.5%) in world there is no use of drug dissolution therapy alone for treatment of common bile duct (CBD) stones which usually combined with endoscopic techniques and other direct dissolution methods, we will discuss and compare our results with these studies since the feasibility of oral bile acids as a dissolution therapy for gall stones
Swobodnik W, Janowitz P et al[10], studied the effect of ursodeoxycholic acid on recurrence prevention of choledochal calculi after endoscopic sphincterotomy was evaluated in 46 patients, whose bile duct stones had been removed endoscopically, 22 patients received 500 mg of Ursodeoxycholic acid once a day, 24 patients received placebo, one recurrent stone could be detected in the ursodeoxycholic acid treated group 19 months after endoscopy, whereas 4 recurrent stones occurred in the placebo group about 16 months after endoscopy

Summary

Introduction

The extra hepatic bile ducts consist of the right and left hepatic ducts, the common hepatic duct, the cystic duct, and the common bile duct or choledochus[1]. About 20 to 25% of patients above the age of 60 with symptomatic gallstones have stones in the common bile duct as well as in the gallbladder. The vast majority of duct stones in western countries are formed within the gallbladder and migrate down the cystic duct to the common bile duct. These are classified as secondary common bile duct stones, in contrast to the primary stones that form in the bile ducts. Endoscopic cholangiography is the gold standard for diagnosing common bile duct stones. It has the distinct advantage of providing a therapeutic option at the time of diagnosis. It should not forgotten that the open approach always remain as final option when others modalities have failed, electrohydrolic lithotripsy, extracorporeal shockwave lithotripsy, laser lithotripsy, and dissolving solutions have especial indications and more clinical trial in this area must be performed[12,13,14,15,16,17,18,19]

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Conclusion