Abstract
In this study, 70 cases of choledocholithiasis were included from general surgery department, Assuit university hospital and Kasr El-Eni university hospital and managed randomly by either approaches including conventional surgery, endoscopic approaches, and laparoscopic techniques.
Ages of our patients were ranged from 20-60 years (mean 40 years), with slight female predominance (female to male = 1.6: 1), most of them presented with calcular obstructive jaundice (54.3%), however other presentations are also encountered as colic, cholangitis, or accidental discovery in 14.3, 10, 21.5% respectively.
Group I (Surgery) includes 30 patients (42.9%) were treated by open choledocholithotomy and T tube insertion, the operative time was 90 (60-180) min. with success rate of the attempted procedures reaching 100%, and CBD clearance of stones was achieved in 96% of cases, hospital stay was 8 (5-12) days, with no mortality and morbidity rate reaches 13% in the form of wound infection, bile leak, missed stone, and CBD stricture with jaundice. The patient can return to work after 2 weeks (12-20 days).
Group II (Endoscopy) include 30 cases (42.9%) treated by endoscopic sphincterotomy and basket extraction in 46%, balloon in 26.6%, combined maneuver in 16.6%, mechanical lithotrepsy in 13.3%, and failure of the technique in one case (3.3%), the procedure time was about 30 (20-45) min. with success rate of attempted procedure 96.7% and CBD clearance of stones was achieved by 100%, with no mortality and morbidity rate of 10% in the form of cholangitis (3.3%) and hyperamylasemia (6.6%), the period of hospital stay was 1 (1-2) days, and patient return to work after 4 (3-5)days.
Group III (Laparoscopy) include 10 cases (14.2%) treated by laparoscopic approaches by trans-cystic approaches in 2 cases, trans-choledochotomy approaches in 3 cases, choledochoscopic techniques in 2 cases, and converted to open techniques with failure of the attempt in 3 cases. The time needed for this procedure was 123 (70-292) min. with success rate about 70%, but CBD clearance of stones reaches 100%, with no mortality and morbidity rate about 20% in the form of hypothermia and hyperamylasemia, the period of hospital stay was 3.2 (2-4) days with return to the work after 12 (5-15) days.