Outcome of Common Bile Duct Exploration without Intraoperative Cholangiography: a Case Series and Review of Literature

Background: Open or laparoscopic surgical exploration of common bile duct (CBD) is performed when endoscopic approaches fail to extract CBD stones. Intraoperative cholangiography (IOC) through T-tube is performed in order to reduce the rate of retained stones. The aim of this study was to evaluate results of CBD exploration without IOC throughT-tube and reviewing existing literature. Methods: A retrospective medical chart review of 392 patients who underwent surgical CBD exploration was performed. All patients had proven CBD stones and had previously undergone failed attempts of endoscopic retrogradecholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES). T-tube insertion or biliary-enteric anastomosiswas performed after open CBD exploration with regard to patient’s presentation and CBD diameter. IOC was not performed after T-tube insertion and cholangiography was postponed until 7th postoperative day. Postoperative retained stone and their management were reviewed.Results: Of 392 patients with CBD explorations, T-tube was placed in 215 (54.8%) including 66 (30.7%) emergentbiliary drainage and 149 (69.3%) elective operations. A number of 177 of 392 (45.2%) patients underwent biliaryentericanastomosis. In 6 of 215 patients (2.8%) with T-tube placement, retained CBD stones were detected by T-tube cholangiography during postoperative period. All of them were treated successfully by ERCP. Conclusions: T-tube placement without IOC is accompanied by a low rate of retained stone. Omitting IOC may decrease the operation time which is especially important in emergent cases. Retained stones following CBD exploration and T-tube placement can be treated successfully using ERCP. Citation: Shojaiefard A, Khorgami Zh, Ghafouri A, Soroush A, Hedayat A, Kaveie E, Ghazi-Nezami B. Outcome ofCommon Bile Duct Exploration without Intraoperative Cholangiography: a Case Series and Review of Literature. Acad J Surg, 2014; 1(2): 60-65.

کلیدواژه ها:

Common Bile Duct ، Cholangiography ، Cholangiopancreatography (ERCP) ، Endoscopic Retrograde ، Sphincterotomy ، Endoscopic ، Gallstones