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Standard Surgical Approaches to Primary Choledocholithiasis — Definitive Versus Temporary Decompression

1992; Hindawi Publishing Corporation; Volume: 6; Issue: 1 Linguagem: Inglês

10.1155/1992/38293

1607-8462

António Castro Mendes de Almeida, Fernando Aldeia, Noel Medina dos Santos, C W Gracias,

Biliary and Gastrointestinal Fistulas

The occurrence of retained/recurrent calculi after primary CBDE followed by temporary T‐tube decompression, have remained at rates varying from 5.4% to 20.9% over the last 10 years in spite of sophisticated pre and intraoperative imaging techniques. It is postulated that a functional obstruction, due to dysmotility of the SO, lies behind most stone‐containing ducts. Thus it seems logical to us that a permanent “fenestration” should be the management of most such ducts. We prospectively followed‐up, for one to 10 years, two groups of patients submitted to primary CBDE aiming to assess the short and long‐term results of two different surgical approaches to duct lithiasis. In one (Group A) 162 CBDE′s were performed, out of 680 CHE′s (24%), with a “positivity” of 68% and in the other (Group B) 80 CBDE′s, out of 438 CHE′s (18%), with a “positivity” of 70%. In Group A a T‐tube decompression was used in 79(49%) and a definitive drainage in 83(51%) whereas in Group B the T‐tube was employed in only 3(4%) and some form of permanent “fenestration” in 77(96%). There were no significant differences between the operative mortality rates, which were 2.5% in Group A (1 death post T‐tube, 3 post CDJ) and 1.3% in Group B (1 death post CDD). The long‐term results, though, were significantly worse among patients of Group A whose ducts were temporarily decompressed: 10/79 (12.7%) required further aggressive interventional therapy for retained/recurrent stones while only 3.8% (3/80) in Group A and 1.3% (1/76) in Group B required revisional surgery for bilio‐digestive anastomotic complications with cholangitis. It is concluded that it is against the long‐term efficiency of the approach utilized in Group B that the new laparoscopic techniques should be compared.