MANAGEMENT OUTCOME OF RESIDUAL COMMON BILE DUCT STONES AT AGA KHAN UNIVERSITY HOSPITAL
AbstractBackground: The frequency of residual common bile duct (CBD) stones in patients with previouscholecystectomy ranges from 2-10%, and a minimally invasive approach is generallyrecommended for these patients. This study reviews the experience in the management of residualCBD stones at the Aga Khan University Hospital. Methods: All adult patients diagnosed to haveresidual CBD stones, from 1993 to 2001, were identified and analyzed in terms of the treatmentmodality utilized and its associated complications. The role of endoscopic sphincterotomy wasparticularly analyzed in our set-up. Results: The study population consisted of 66 patients. Themean age was 52 (range:18-84 years) years with a female to male ratio of 51:15. The primarymode of management consisted of endoscopic sphincterotomy in 61 patients (92.5%). The initialclearance rate for these patients was 75%, while the remaining 25% required ancillary proceduresto achieve a complete clearance. Procedure related complications were observed in 17 (28%)patients, with zero mortality. The other 5 patients (7.5%) underwent an open choledochotomy as aprimary procedure with no further complications. Conclusions: Endoscopic sphincterotomy is themost frequent treatment modality used for the management of residual CBD stones at our hospital.Although initial success rate seems low, the fact that endoscopic sphincterotomy is a less invasiveprocedure justifies its preferential utilization. The study does not compare the results ofendoscopic management with open surgery, as the number of patients managed by opencholedochotomy is very small.Keywords: Common bile dust stones, Retained common bile duct stones, Endoscopicsphincterotomy, Endoscopic retrograde cholangiopancreaticography
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