Laparoscopic management of CBDS an alternate to ERCP

Abdul Aziz Laghari, Prof. LUMHS JAMSHORO PAKISTAN

OBJECTIVE: To evaluate ,applicability,  safety and advantage of laparoscopic technique to remove CBD stone an alternate to ERCP.

SETTINGS: DEPARTMENT OF SURGERY AND MISC LIAQUAT UNIVERSITY HOSPITAL HYDERABAD/ JAMSHORO.

METHODS: All fit patients were selected for lap CBD group. Patients were optimised, underwent baseline and specific investigation. Patient with CBD, moderate to high risk for anesthesia and Ca Gallbladder were excluded from study.In ERCP group unfit patients and patients preference for ERCP were included.

RESULTS: During five year study period total 130 patients diagnosed as CBD stones. Female patients 105, Male patients 25. In ERCP group total patients 85, 75 female and 10 were male. Common age group was between 31 to 61 years. 1.5 cm size of CBD seen in 42 patients. Choledocotomy done in 97 patients. Primary closure of CBD 108 patients,  T tube insertion in 14 patients,  Biliary bypass in 04 patients,  conversion to open in 03 patients. While ERCP group papilotomy is the procedure of choice in 72 patients. Duodenal haemorrhage seen in 01 patient, underwent for open surgery.

CONCLUSION: Success rate was high in lap CBD group , simultaneously laparoscopic cholecystectomy was another advantage , 0 % motality,  0% pancreatitis.  Hence we found laparoscopic approach superior to ERCP for management of CBD stones.

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