Parasites and Biliary stones
Parasites and Biliary stones
Parasites and Biliary stones
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Treatment of calcular obstructive jaundice ٨٤<br />
Operative management consists of choledocholithotomy(CBD<br />
exploration <strong>and</strong> stone retrieval) <strong>and</strong> biliary drainage procedures. The<br />
latter consists mainly of choledochoduodenostomy <strong>and</strong> Roux-en-Y<br />
choledochojejunostomy. These 1-stage operations as superior in outcome<br />
<strong>and</strong> cost efficiency as compared with other interventions as laparoscopic<br />
cholecystectomy <strong>and</strong> ERCP ( Schwartz, 1999).<br />
Laparoscopic cholecystectomy emerged as a minimally invasive<br />
alternative to open cholecystectomy. However, by the mid 1990s,<br />
laparoscopic surgeons had crossed the cystic duct to tackle common duct<br />
<strong>stones</strong> <strong>and</strong> since have challenged the role of therapeutic ERCP.Two<br />
approaches to CBD exploration are possible: the transcystic <strong>and</strong> direct<br />
choledochotomy. The transcystic approach is preferable because it avoids<br />
a direct incision of the CBD with the need for subsequent suture closure<br />
<strong>and</strong> T tube placement (Ido et al., 1996).<br />
Direct choledochotomy requires considerable skill <strong>and</strong> experience in<br />
laparoscopic biliary surgery. Compared with transcystic removal, the<br />
operative time <strong>and</strong> postoperative hospital stay are longer <strong>and</strong> the<br />
procedural complication rate is higher. Direct complications of<br />
choledochotomy include bile duct leakage <strong>and</strong> bile duct strictures<br />
(Strasberg et al., 1996).
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