Management Of Common Bile Duct Stones – Different Modalities

Background and Objectives: “Management of Common Bile Duct-Different Modalities”, is a prospective study comparing the three different modalities viz. endoscopic retrograde cholangio pancreatography (ERCP), open CBD exploration and laparoscopic CBD exploration. The study was conducted with an objective to compare and contrast these different modalities and to study the advantage of ERCP over surgical methods. Methods: 50 cases of common bile duct stones admitted in JSS Medical College Hospital, Mysore,were selected for the study. After pre procedure work up patients were subjected to either or combination of procedures namely ERCP, open CBD exploration, laparoscopic CBD exploration. The age/ sex distribution, the clinical presentation, the investigations, the treatment modalities, the complications and the outcome were evaluated. Results: In this study of 50 patients, 39 patients underwent ERCP with successful stone extraction in 24 patients and in 7 patients incomplete duct clearance was obtained and 8 patients had failed ERCP. 22 patients underwent open CBD exploration with T tube closure in 18 and 3 patients underwent cloledochoduodenostomy and in 1 patient trans duodenal sphincterotomy was performed. 4 patients underwent laparoscopic CBD exploration with 1 converted to open procedure. 3 patients underwent choledochotomy with extraction of stones and primary closure of CBD with ante grade biliary stenting. Conclusion: Management of CBD stones in each patient needs to be individualized for different modalities depending upon the need and the indication. However the preferred method based on our study is subjecting the patient to pre operative ERCP followed by laparoscopic cholecystectomy.