Management of common bile duct calculi in a tertiary care hospital in North East India

Background: Common bile duct calculi are frequently encountered in patients with cholelithiasis. Treatment ranges from endoscopic retrograde cholangiopancreatography (ERCP) to various surgical treatment modalities done either by laparoscopic or open techniques.Methods: This was a retrospective cross-sectional study carried out in General Surgery department of NEIGRIHMS Hospital from April 2014 to March 2020. Patients attending the hospital with choledocholithiasis during the time period have been included in the study.Results: A total of 82 patients were included in the study. The prevalence of common bile duct (CBD) calculi in patients attending NEIGRIHMS Hospital with symptomatic gallstone diseases was 5.16%. Treatments ranged from primary CBD closure or T-tube drainage after CBD exploration either by laparoscopic techniques, choledocho-duodenostomy and ERCP. Bile peritonitis in 9 patients and retained stone were observed in some patients who were managed accordingly. No mortality was seen in any patient.Conclusions: The number of patients with CBD calculi and symptomatic gallstone disease attending NEIGRIHMS Hospital is less and standard of care is provided to the patients with acceptable morbidity and mortality.

Strategies for endoscopic and surgical management of common bile duct stones

Introduction Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitis. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. Classification From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs,2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. Discussion Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. Conclusion Common bile duct calculi represent a common disease of the digestive system. Endoscopic diagnostic procedure is very important in management of choledocholithiasis Endoscopic treatment of common bile duct calculi prior to cholecystectomy is a method of choice and a strategy for associated cholecysto-choledocholithiasis.