الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Choledocholithiasis, if left untreated, can lead to significant morbidity and mortality. There are several approaches and current data does not suggest clear superiority of any one approach; decisions regarding treatment are most appropriately made based on surgeon preference as well as the availability of equipment and skilled personnel.While selecting the operative technique to treat choledocholithiasis, single-stage procedures should be given the priority, as they lead to less morbidity and short hospital stay. This study was carried out in the department of General surgery Zagazig University Hospitals in the period from January 2013 to January 2015. This study included 30 patients (11 males (36.6) and 19 females (63.4) and their ages ranged from 18 to 80 years with a mean age of mean age (42.5±15.7). having gall stones and common bile duct calculi. The criteria of selection of these patients were based on history, clinical evaluation, laboratory evaluation and the imaging studies done for our patients. Table [2] which shows the inclusion and exclusion criteria for this study.Our results show: Group [A]:- The procedures were completed in 13 cases (86.6%) with 2 cases converted to open surgery (13.33%). The conversion include one case in whom CBD clearance could not be achieved due to impacted large stone in its lower part with failed CBD cannulation and one case due to presence of the papilla in the floor of large duodenal diverticulum. The diameters of the stones removed ranged between 5 mm and 15mm. The procedure time ranged from 145 to 180 minutes with a mean of 160 ± (10.4) minutes. In early cases time of the procedures was a longer than in late cases. Our procedure mean operative time was 160 minutes. And as regards efficacy of CBD clearance it was 86.6% (two cases failed ERCP converted to open and no patients with retained CBD stones postoperatively recorded in this group.Postoperative complications occurred in 2 patients [13.3%] and were minor complications in the form of mild pancreatitis with elevation of serum amylase. Group [B]:- The procedures were completed in 12 cases (80%) with 3 cases was converted to open surgery (20%) two due to severe adhesions in Calot’s triangle and one due to impacted large stones 2 cm with no available lithotripsy. The diameters of the stones removed ranged between 8 mm and 24 mm. The procedure time ranged from 160 to 190 minutes with a mean of 176.4 minutes. As regards efficacy of CBD clearance it was 73.33% (three cases converted to open and one patients with retained CBD stones postoperatively recorded in this group).
Postoperative complications occurred in three patient [20%] and were minor complications in the form of minimal biliary leakage in the subhepatic drain and was managed conservatively, pneumonia and infection with t-tube. Conclusion•There was no statistically significant difference between the two groups in terms of surgical time, surgical success rate, postoperative complications, mortality rates and retained common bile duct stones, while the postoperative length of hospital stay was longer in patients undergone LCBDE the procedure cost was higher in patients undergone ERCP. During the course of this study we noted that:Numerous factors must be considered in selecting the most appropriate treatment for each case, such as the patient’s general condition, and the number, size, and anatomic location of the bile stones. The experience and skill of surgeons and endoscopists are also important components of the treatment.- ERCP is more prefereable in case of: documented CBD stones in CBD 10 mm in diameter, cholangitis, biliary pancreatitis, LCBDE failures and suspecting Malignancy. LCBDE is more preferable in case of: - multiple large calculi in CBD 10 mm in diameter, ERCP failures, young patients, economic demanding reasons and if we are in doubt about the presence of CBD ston.