Evaluation of effect of cholecystectomy on common bile duct diameter using ultrasonography and liver function test: a prospective study

Background:Different factors influencing the post cholecystectomy CBD diameter have been implicated. Ultrasound has emerged as a diagnostic imaging method of choice for liver and extrahepatic biliary system. In order to differentiate the diagnosis of asymptomatic bile duct dilatation, one needs to perform either MRCP or ERCP, which are both expensive and/or invasive test. Therefore, it is necessary to understand the physiological changes in bile duct after cholecystectomy to reduce unnecessary testing for early detection of bile duct lesions.Methods: 100 cases of gall stone disease undergoing cholecystectomy in the department of surgery were studied. Pre operative and Post operative Ultrasound whole abdomen with focus on CBD diameter and Liver function test were done, Post operative data was collected on 10th day and again after 3 months. The data was compiled, compared and analysed.Results:The mean preoperative diameter was 4.12 mm, postoperatively, the mean diameter of the CBD in early follow up period i.e. at 10th day and at 3 months, was found to be 4.75 and 5.14 mm respectively. The difference between mean preoperative and mean postoperative (10th day follow up) diameter was found to be 0.63 mm (p<0.01). The difference between mean preoperative and mean postoperative (3 months follow up) diameter was found to be 1.02 (p<0.01) mm, both statistically significant. Conclusions:Significant compensatory dilatation does occur in common bile duct diameter after cholecystectomy in most of the patients.

ROLE OF ERCP;

Objective: To determine the efficacy of ERCP in acute severe biliary pancreatitis inrelation to rate of complications and hospital stay. Patients and Methods: 30 patents wereincluded in the study, divided into ERCP group & Non ERCP group. The study was conducted atSurgical Unit-I, Holy Family Hospital Rawalpindi from July 2009 to April 2011. ERCP Groupcomprised of 11 patients and non ERCP Group 19 patients. All patients having severe acutebiliary pancreatitis raised alkaline phosphatase and common bile duct diameter >8mm wereincluded in the study. Results: In ERCP Group, there were 3 males and 4 females with mean age42.77 ± 14 years. In non ERCP group there were 17 males and 2 females with mean age 46.76 ±13 years. ERCP was done within 3 day in 8 patients and within 7 day in 5 patients in ERCP group.The rate of complications in both groups was insignificant (P= .92). The length of hospital stayalso does not differ significantly between two groups (P=.874). Conclusions: In our set up therewas no significant difference in outcome in ERCP and non-ERCP group of severe acutepancreatitis. However, in ERCP group intervention was mostly performed after 72hrs.