Surgery

Biography

Biography: Emad Hamdy Gad

Abstract

Objectives: Since the introduction of ERCP and LC, the majority of patients suffering from concomitant gallstone and CBD stone have been managed by endoscopic extraction before or after cholecystectomy.   However, for complicated large difficult CBD stones that cannot be extracted by ERCP, patients can be managed safely by open or laparoscopic CBD exploration. The aim of this study was to assess these surgical procedures of CBDE after endoscopic failure. Methods: We retrospectively reviewed and analyzed 85 patients underwent surgical management of large difficult CBD stones after ERCP failure, in the period from mid 2011 to mid 2016. The overall male/female ratio was 27/58. Results: Sixty seven (78.8%) and 18(21.2%) of our patients underwent single and multiple ERCP sessions respectively with significant correlation between number of ERCP sessions and post ERCP complications (P=0.001).  Impacted large stone was the most frequent cause of ERCP failure (60%). LCBDE and OCBDE were 29.4% (n=25), 70.6% (n=60) respectively. Primary CBD repair, T-tube insertion, HJ and TDS were done in 45.9%, 40%, 8.3% and 5.9% respectively. The mean operative time and hospital stay were 185± 61.4 minutes and 4.9±2.07 days respectively.  Conclusion: Large difficult CBD stones can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, choledocoscope has a good impact on stone clearance rate with direction towards doing primary repair that is better than T-tube regarding operative time and hospital stay.