EP.FRI.199 Impacted common bile duct stone managed by hepaticoduodenostomy

Abstract The management strategy of common bile duct stone will depend on personal experience, equipment availability, time and the availability of other departmental expertise. For a distally impacted common bile duct (CBD) stone in a low resource setting, an open approach will entail either leaving the stone where it is and carry out a choledochoduodenostomy, or removing the stone through a transduodenal sphincteroplasty. The latter has a significant risk of causing an acute pancreatitis. A case report of a hepaticoduodenostomy performed on a 40-year-old black African man for a retained, impacted distal CBD stone in a low resource setting with a good outcome is presented. The impacted CBD stone had complicated an open cholecystectomy for acute cholecystitis by causing the dehiscence of the cystic duct stump as a result of distal biliary obstruction. A bypass procedure such as a hepaticoduodenostomy may be an alternative to the traditional choledochoduodenostomy in the management of the retained, impacted distal CBD stone especially in the presence of sepsis. A wide side- to-side hepaticoduodenostomy (>3cm d) is a safe and definitive procedure for the decompression of lower CBD obstruction and has good long-term results with infrequent complications including reflux cholangitis, hepatic abscess, stone recurrence, pancreatitis and the ‘sump’ syndrome. This case demonstrates that a hepaticoduodenostomy is safe and effective in rescuing the adverse sequelae of an impacted distal CBD stone in a low resource setting.

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Is primary closure of common bile duct a rational method after choledocholithotomy, in a low resource setting?

Hellenic Journal of Surgery ◽

10.1007/s13126-017-0372-8 ◽

2017 ◽

Vol 89 (1) ◽

pp. 18-23

Author(s):

Sumitra Hagjer ◽

Abdul Rahim Shaan ◽

Yogesh Shukla

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Primary Closure ◽

Rational Method ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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Study on 60 cases of common bile duct stone, there different modality of management and its inference

International Surgery Journal ◽

10.18203/2349-2902.isj20203776 ◽

2020 ◽

Vol 7 (9) ◽

pp. 2960

Author(s):

Sovat Lal Ahirwar

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Common Bile Duct Stone ◽

Bile Duct Stone ◽

Research Centre ◽

Surgical Methods ◽

Surgical Emphysema ◽

Cbd Stone ◽

Clinical Conditions ◽

Cbd Exploration

Background: The aim of the study was to determine the best treatment modality for common bile duct stone become more challenging as large number of options available such as endoscopic, laparoscopic or open surgical methods, we need to choose specific therapy according to patient’s clinical conditions, and individual expertise.Methods: It is prospective study including 60 patient having common bile duct stone along with gall bladder stone, its different modality of management and its inference, conducted in Bhopal Memorial Hospital and Research Centre, Bhopal, during period of January 2017 to January 2020.Results: In 60 cases 41 patients undergoes to endoscopic retrograde cholangio pancreatography (ERCP) first, stone successfully removed in 34 patients and stent placed, one patients developed pancreatitis after ERCP, managed conservatively, In 6 patients retained stone after ERCP procedure, one patients developed surgical emphysema after procedure, managed with ICD and conservatively, and one patient had bleeding during sphincterotomy so its procedure abandoned and one of the patient failed to cannulate common bile duct (CBD). 21 patients undergo laparoscopic common bile duct explorations, 2 lap CBD exploration converted to open CBD exploration with cholecystectomy, due to adhesion at hepatocystic triangle. Five patients undergoes open CBD exploration, in one patient hepaticojejunostomy was done as patient was having CBD stone with stricture. No mortality during and after procedure.Conclusions: Management of CBD stone is depends upon individual expertise and available modality. If surgeons are expertise then lap CBD exploration with cholecystectomy without attempting to ERCP guide stone removal is best approach in majority of patients.

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