Hassan Farrukh, Gaurav Kumar, Kumar Krishan, Kumar Kamlesh, A Praveenkumar, N Venkatesh, Sahu Swaroop Sanat, Mahto Sameer Kumar, B Balamurali
General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND.
Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND.
Cureus. 2024 Oct 14;16(10):e71438. doi: 10.7759/cureus.71438. eCollection 2024 Oct.
Choledocholithiasis, or stones in the common bile duct (CBD), has two types: primary stones that form in the CBD and secondary stones that migrate from the gallbladder. Management includes endoscopic, laparoscopic, and open surgical methods. In India, the availability of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery is limited often necessitating open procedures. Commonly, open choledochotomy followed by T tube placement was performed. However, postoperative management/management of retained stones can be challenging, requiring referrals for ERCP or revision surgery. This study aims to compare the outcomes of choledochoduodenostomy versus the T tube approach in a hospital setup where ERCP is either unavailable or cumbersome.
This was a retrospective comparative study carried out at Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India. The study was approved by the Institutional Ethics Committee of RIMS, Ranchi. A total of 62 patients who underwent operations for choledocholithiasis (CBD dilation ≥ 1.2 cm) from January 2023 to January 2024 in the Department of General Surgery of RIMS, Ranchi, were analyzed.
The mean age group was 52 years ± 11.5 years, and two-thirds were females with a male-to-female ratio of 1:1.8. The most common presentation was biliary colic (87 %), followed by jaundice (45%). Around three-fourths of them had multiple calculi (n = 46). A total of 36 patients underwent T tube (58.1%) and 26 underwent choledochodudoenostomy (41.9 %). The mean operating time was higher for the T tube approach but not statistically significant. The hospital stay for the patients was significantly higher for the T tube approach with a p-value of <0.001. The mean T tube in situ duration was 17.60 days ± 1.2 days. On performing a T tube cholangiogram postoperatively, it was observed around one-fourth of them had T tube filling defect (n = 8), signifying the residual stone presence and referral to higher center due to unavailability of ERCP. The incidence of wound infection was significantly high among the patient who underwent T tube with a p-value of 0.017, and postoperative bile leak was significantly high among the patient who underwent T tube with a p-value of 0.047.
Based on our retrospective analysis, we suggest choledochoduodenostomy was safer and more efficient in aspects of lesser operating time, minimal hospital stay, less or nil retained stones, lesser postoperative wound infection, bile leakage, and possessing advantages especially to elderly patients both economically and psychologically.
胆总管结石，即胆总管（CBD）内的结石，有两种类型：在胆总管内形成的原发性结石和从胆囊迁移而来的继发性结石。治疗方法包括内镜、腹腔镜和开放手术。在印度，内镜逆行胰胆管造影术（ERCP）和腹腔镜手术的可及性有限，常常需要进行开放手术。通常采用开放胆总管切开术并放置T管。然而，术后管理/残留结石的处理可能具有挑战性，需要转诊进行ERCP或再次手术。本研究旨在比较在ERCP不可用或操作不便的医院环境中，胆总管十二指肠吻合术与T管置入法的治疗效果。
这是一项在印度贾坎德邦兰契市拉金德拉医学科学研究所（RIMS）进行的回顾性对照研究。该研究获得了RIMS兰契市机构伦理委员会的批准。对2023年1月至2024年1月期间在RIMS兰契市普通外科接受胆总管结石手术（胆总管扩张≥1.2 cm）的62例患者进行了分析。
平均年龄组为52岁±11.5岁，三分之二为女性，男女比例为1:1.8。最常见的表现是胆绞痛（87%），其次是黄疸（45%）。其中约四分之三的患者有多发结石（n = 46）。共有36例患者接受了T管置入（58.1%），26例接受了胆总管十二指肠吻合术（41.9%）。T管置入法的平均手术时间较长，但无统计学意义。T管置入法患者的住院时间显著更长，p值<0.001。T管平均留置时间为17.60天±1.2天。术后进行T管胆管造影时，发现约四分之一的患者存在T管充盈缺损（n = 8），表明有残留结石，由于无法进行ERCP而转诊至上级中心。接受T管置入的患者伤口感染发生率显著较高，p值为0.017，接受T管置入的患者术后胆漏发生率显著较高，p值为
