title: Experience with common bile duct exploration at Lumbini Medical College.
abstract: Common bile duct stones represent a significant danger to patients, because they can lead to biliary colic, obstructive jaundice, cholangitis, or pancreatitis. Common bile duct stones either migrate from the gallbladder or form primarily within the bile ducts themselves. Primary stones are more common in South Asia and are usually sequelae of biliary infection and stasis. In the United States and other Western countries, common bile duct stones are predominantly secondary stones, having formed in the gallbladder. In patients who have gallstones, and in whom a cholecystectomy is considered, common bile duct stones can be found preoperatively, intraoperatively, or postoperatively. Ten percent to 15% of patients undergoing a cholecystectomy will be found to have choledocholithiasis at some point during their treatment. We present our case of 16 patients of common bile duct stones with or without cholelithiasis from April 2011 to March 2012. To review the treatment and outcome of patients with common bile duct (CBD) stones who underwent cholecystecomy with open common bile exploration (CBDE). We analysed the fact that cholecystectomy with commonbile duct exploration still holds as a good modality of treatment where ERCP (Endoscopic Retrograde cholangio pancreaticogram) is not available. All 16 persons in age group of 20-65 years, all females with body weight in the range of 45-60 kgs undergoing inpatient common bile duct exploration during April 2011- March 2012 were included. Common bile duct exploration was successful in all patients. Mean operating time was 120 +/- 40 minutes and length of hospital stay was 13 +/- 3days. 3 complications (18.75%) were recorded, 2 cases of retained stone (12.5%) who underwent choledochoduodenostomy. In 16 patients undergoing common bile duct exploration, CBD stones were discovered with flexible choledochoscope and intraoperative cholangiography. None of the Gallbladder specimen revealed any feature of malignancy in final histopatholgical report. All patients are doing fine till date. Open common bile duct exploration can still be a gold standard technique in set up where ERCP is not available. The results of common bile duct exploration are good with less complications in experienced hands.
authors.affiliation: Department of Surgery, Lumbini, Medical College, Pravas, Tansen, Nepal. nabindai@yahoo.com
authors.forename: N
authors.initials: N
authors.lastname: Pokharel
authors.forename: P
authors.initials: P
authors.lastname: Sapkota
authors.forename: B
authors.initials: B
authors.lastname: Kc
authors.forename: S
authors.initials: S
authors.lastname: Rimal
mesh_terms: D000328:Adult; D000368:Aged; D002758:Cholangiography; D002763:Cholecystectomy / Q000009:adverse effects; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D016896:Treatment Outcome; D055815:Young Adult