SSAT - MANAGEMENT OF CBD STONES IN A COMBINED ENDOSCOPIC AND LAPAROSCOPIC SERVICE OVER A 5 YEAR PERIOD

Back to 2018 Posters

MANAGEMENT OF CBD STONES IN A COMBINED ENDOSCOPIC AND LAPAROSCOPIC SERVICE OVER A 5 YEAR PERIOD
Abhijeet Acharya, Mohan Narasimhan, Alagammai Palaniappan, Ramesh Ardhanari^*
G.I.Surgery, Meenakshi Mission Hospital, Madurai, India

775 patients were treated for cbd stones from jan 2012 to jun 2017 at our institute. 395 patients were males and 380 were females. The median age was 56yrs( 6 - 93 yrs). Pain was the major presenting complaint (31%) closely followed by pain + vomiting (13.5%) and pain + jaundice (11.2%). The classical charcot triad was present in 56 patients (7.2%). 106 patients had prior history of biliary intervention ( 40 cholecystectomies, 8 cbd explorations, 22 ERCP+ES, and 3 choledochoduodenostomies).
Liver function tests included Bilirubin,SGOT,SGPT,GGTP and ALP levels. 328 patients had all parameters deranged, 112 had derangement in Bili/OT/PT/GGTP levels.. 58 patients had normal LFTs. 56 patients had elevated S.amylase and lipase levels consistent with pancreatitis. Endoscopic Ultrasound was performed on all patients at our hospital. Our data showed (95.75%) and PPV (95.27%) over MRI(Sensitivity 93.5%, PPV 95.08%). This was followed by ERCP on the same day if EUS was positive. Only sick patients with cholangitis underwent ERCP drainage as primary procedure.
Of the 1592 ERCPs performed, 728 were performed for CBD stones. Our Success rate 87.6% (638 success with 90 failures).
In 338 patients, laparoscopic cholecystectomy was performed within 48 hrs of the ERCP and were discharged home with 3-5 days of hospital stay. 11 patients were stented initially and the procedure repeated after 48-96 hrs with successful cbd clearance.There were no cases of pancreatitis,perforeation following ERCP.2 patients had malena managed conservatively.There were no conversions from Laparoscopy in either the immediate or delayed group.No patient presenting with CBD stones died within 90 days after procedure.

Surgical Intervention was required in 102 cases. There were 67 laparoscopic explorations and 25 open exploration. Of these, 74 were CBD exploration with stone retrieval and closure/ t tube placement, 9 were choledochoduodenostomies. Choledochoscope was used in 33 cases to confirm stone clearance
This study shows that a strategy of combined use of EUS,ERCP and Laparoscopy results in excellent success rates of clearance,s in LC and no mortality over a large series of cases.

Back to 2018 Posters