Is it time to write obituary for open choledocholithotomy in the present era of endoscopic management? Outcome of surgery for failed endoscopic extraction, retrospective study

Abstract

INTRODUCTIONThe prevalence of choledocholithiasis has been estimated to be 05 to 20 percent of patients undergoing cholecystectomy. [1][2][3][4] Methods:We reviewed the outcome of patients operated at our centre after failed endoscopic clearance of CBD stones. Over a period of 03 years, total 2145 laparoscopic/open cholecystectomies were performed at our institute. In the same time period, 14 patients (06 males and 08 females) presented with choledocholithiasis after failed ERCP extraction (median age 59 years, range 29-62 years). All the patients had undergone ERCP and ± sphincterotomy/sphincteroplasty with failed clearance. None of the patient had undergone a cholecystectomy previously. Results:We performed open choledocholithotomy with T-tube drainage plus cholecystectomy in all the patients. There were no deaths and only one major complication. Surgery resulted in complete duct clearance in 93% of patients. Conclusions: Open surgery can be performed safely and effectively in patients with retained bile duct stones and surgery can be offered as primary modality of treatment over combined endoscopic management after appropriated patient selection.