Comparative Study of Endoscopic Retrograde Cholangio-Pancreatography versus Surgical Open and Laparoscopic Exploration of CBD in Management of CBD Stones

Abstract

Introduction and Aim: Choledocholithiasis are common presentations in daily surgical practice. Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard management approach. However, researching new approaches is continuing due to their associated complications. The current study aimed to address the efficacy, safety, and outcomes of different treatment modalities to recognize the most appropriate technique for patients with choledocholithiasis.

Patients and methods: The current work included 60 patients with choledocholithiasis. They were divided randomly into three equal groups. Group I for intraoperative ERCP plus LC, group II for LCBDE plus LC, and group-III for open common bile duct exploration plus cholecystectomy. Each patient was subjected to full history taking, physical examination, and different investigations (laboratory and radiological). The postoperative follow-up had been performed in the clinical and radiological follow-up.

Results: The three groups were comparable regarding patient age, sex, body mass index, operative time, size of the common bile duct, stone number per patient, postoperative pain score, duration of hospital stay, satisfaction score. The success rate was 75%, 70% & 85% of the group I, II & III, respectively; while the mortality rate was 5%,10% & 0% in groups I, II, and III. However, there was a statistically significant higher frequency of morbidity among Group-I than the other two groups (30% in group I compared to 5% for each of the second and third groups). Also, there was a higher rate of retained stones (25%, 30%) for groups I & II with no retained stones among the third group (open surgery).  There was no significant difference between groups regarding complications.

Conclusion: The three approaches have comparable outcomes in success, mortality, morbidity, failure, and complications. The clearance and retained stone rates after primary intervention showed significant improvement in the open surgery group compared to the other groups.