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SURGICAL MANAGEMENT OF IMPACTED LOWER COMMON BILE DUCT STONES

Author: Mohammed H Al-Jawher
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2012 Volume: 18 Issue: 2 Pages: 47-52
Publisher: Basrah University جامعة البصرة

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Abstract

Common bile duct stones have been noted in 10-15% of patients with gall stones, these stones are either primary (formed in the common bile duct) or secondary (formed in the gallbladder and migrate down to the common bile duct). Their management includes ERCP, biliary drainage procedure and choledochal exploration. In this interventional study we reviewed transduodenal sphincteroplasty as an option for surgical treatment of impacted lower CBD stones from a point of morbidity and mortality. A prospective study conducted over a period of 10 years from 2000 to 2010 in Basrah Teaching General Hospital and private hospitals in Basrah. Twenty three patients with impacted lower CBD stones, there were 17 females (73.9%) and 6 males (26.1%) included in this study. The impacted lower CBD stones and surgical jaundice are the main indications for surgery to which 23 patients underwent TDS. All surgeries done in elective lists. In this prospective study, 23 patients who were diagnosed as impacted lower CBD stones managed by TDS,17 (73.9%) were females and 6 (26.1%) were males. In patients with impacted lower CBD stones who underwent TDS as an option for surgical treatment, 3 patients (13.04%) developed duodenal leak, 2 of them treated conservatively and improved, while 1 patient re-explored. Two patients (8.69%) developed mild cholangitis which respond to conservative measures. The hospital stay for all patients ranges 5–14 days postoperatively, with mean stay of 7 days. No reported cases of postoperative pancreatitis following TDS in this study. No mortality reported (0 %) in follow-up for 2 years in our study. It is concluded from this prospective study that TDS in the surgical management of impacted lower CBD stones with fibrosed ampulla (sphincter of oddi) is a feasible option with accepted incidence of duodenal leak and cholangitis among the biliary drainage procedures especially in an area where the facility of ERCP are not present or failed in addition of dense adhesions in supraduedenal area intra-operatively when decisions of open abdominal exploration done, make supraduedenal CBD exploration difficult and hazardous.

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Article
THE IMPACT OF THE GALLBLADDER WALL THICKNESS ASSESSED BY SONOGRAPHY ON THE OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY

Authors: Ali Dawood Al-Hilfi --- Mohammed H Al-Jawher --- Safwan A Taha
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 2 Pages: 30-36
Publisher: Basrah University جامعة البصرة

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Abstract

Laparoscopic cholecystectomy first became popular during the late 1980s and now the procedure is consider the standard approach for symptomatic cholecystolithiasis. This study aimed to assess the value of sonography in predicting intraoperative difficulties for patients undergoing laparoscopic cholecystectomy and in identifying indicators for conversion to open cholecystectomy. This prospective clinical trial conducted in the Department of Surgery of Al-Sadir Teaching Hospital, Al-Mousawi private Hospital and Ibn Al-Baitar private Hospital in Basrah, Iraq, between January 2006 and October 2007. Abdominal sonography performed in 100 consecutive patients before laparoscopic cholecystectomy. The surgeon re-verified sonographic findings in the operating room. Out of 100 patients with cholecystolithiasis on sonography, we encountered straightforward laparoscopic cholecystectomy in 72 patients (72%), difficult laparoscopic cholecystectomy in 20 (20%) and the procedure was converted to open cholecystectomy in 8 patients (8%). Forty two patients had sonography revealing gallbladder wall thickness (>4 mm). The accuracy of sonography for cholecystolithiasis was 99%. In conclusion, an accurate preoperative diagnostic sonography is mandatory for planned laparoscopic gallbladder surgery to provide information for the selection of the most appropriate approach and to avoid intraoperative difficulties and surprises. On sonography, gallbladder wall thickening is the most sensitive indicator of technical difficulties during laparoscopic cholecystectomy, such difficulties may require conversion to laparotomy.

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