Incidence and management of cases of calcular obstructive jaundice with failed endoscopic retrograde cholangiopancreatography: a 2-year experience

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Abstract

Background
The ‘gold standard’ for management of gallstones is laparoscopic cholecystectomy, but there is no consensus for treatment of common bile duct stones. There is insufficient information in the literature on the practice of laparoscopic common bile duct exploration (LCBDE) in cases of endoscopically irretrievable stones. This study presents the technical aspects and results of this approach and comparing it with open common bile duct exploration (OCBDE).
Aim
To assess the management of the patients with calcular obstructive jaundice after failed endoscopic retrograde cholangiopancreatography with LCBDE in comparison with OCBDE.
Patients and methods
A prospective randomized study was conducted for 2 years started from 2017 to 2019 in Theodor Bilharz Research Institute. A total of 600 patients with calcular obstructive jaundice underwent endoscopic retrograde cholangiopancreatography, with failure of stone extraction in 50 patients. Of them, 30 patients underwent LCBDE and the other 20 patients underwent OCBDE. Overall, 40 patients were female and the other 10 were male. They ranged in age from 23 to 80 years old, with a mean age of 46.72 years.
Results
The mean postoperative hospital stay, pain score, and analgesia score were significantly short (<0.05) and less in laparoscopic than OCBDE. The mean intraoperative blood loss, bile leak, and postoperative wound infection were less in laparoscopic than OCBDE, and the mean operative time was less in open than LCBDE (>0.05) but with no statistically significant difference.
Conclusion
LCBDE considered as a safe, efficient and preferred procedure for CBDE whenever possible.

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