TRUE/FALSE statements regarding management of CBD stone are: 1. Endoscopic papillotomy 2. Ursodeoxycholic acid 3. ERCP 4. Hepaticojejunostomy 5. Choledochotomy
Correct Answer: 1,2,3,5 true & 4 false
Description: Hepaticojejunostomy is not indicated in management of CBD stone. Management of CBD stone Endoscopic papillotomy is the preferred first technique with sphincterotomy, removal of the stones during a dormia basket or the placement of stent if the stone removal is not possible. Endoscopic cholangiography: the use of endoscopic cholangiography in patients with suspected common bile duct stone not only confirms the diagnosis but also provides ductal clearance of the stone and sphincterotomy before subsequent laparoscopic cholecystectomy. Patients with worsening cholangitis, ampullary stone compaction, biliary pancreatitis, multiple comorbidities, and cirrhosis are considered good candidate for preoperative endoscopic therapy. Endoscopic sphincterotomy with stone extraction is well tolerated in most patients, with 5%to 8% complication rate. Complete clearance of all common duct stones is achieved endoscopically in 71% to 75% of patients at the first procedure and in 84% to 95% of patients after multiple endoscopic procedures. Laparoscopic common bile duct exploration through the cystic duct or with formal choledochotomy allows the stones to pass during the procedure. An open common bile duct exploration should be performed if endoscopic intervention is not available or not feasible because of anatomical restrictions or expeise. If choledochtomy is performed, a T tube is left in place. The purpose of the T tube is to provide access to the biliary system for postoperative radiologic stone extraction. With the increased use of endoscopic, percutaneous, and laparoscopic techniques, open bile common duct exploration is rarely performed today. Stone impacted in the ampulla may be difficult for both endoscopic ductal clearance and common bile duct exploration. In these cases, transduodenal sphincteroplasty and stone extraction should be performed; alternatively, if this is not successful, a choledochoduodenostomy or a Roux-en Y choledojejunostomy should be performed. The widespread use of laparoscopic cholecystectomy and ERCP has decreased the incidence of complicated biliary tract disease and need for choledocholithotomy and T tube drainage of the bile ducts. EBS followed by spontaneous passage or stone extraction is the treatment of choice in the management of patients with common duct stones, especially in elderly or poor risk patients. Ursodeoxycholic acid It is one of the secondary bile acids, which are metabolic byproducts of intestinal bacteria. The drug reduces cholesterol absorption and is used to dissolve (cholesterol) gallstones in patients who want an alternative to surgery. It is the only FDA approved drug to treat primary biliary cirrhosis. Ref: Sabiston 18/e, Page 1560-61; Bailey & Love 25/e, Page 1126.
Category:
Surgery
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