Online ISSN: 2515-8260

Keywords : Choledocholithiasis


A PROSPECTIVE COMPARATIVE STUDY OF THE OUTCOMES BETWEEN CHOLEDOCHODUODENOSTOMY AND CHOLEDOCHOLITHOTOMY WITH T-TUBE CLOSURE IN MULTIPLE CBD STONE

Dr. Biswaraj Sarkar, Dr. Anarsh Debbarma, Dr. Rajib Debnath

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 16-20

Background: Common Bile Duct Stones (CBDS) are one of the medical conditions leading to surgical intervention. They may occur in 3% 14.7% of all patients for whom cholecystectomies are performed. When patients present with CBD STONES, the one important question that should be answered: what is the best modality of treatment under the given conditions? There are competing technologies and approaches for diagnosing CBDS regarding diagnostic performance characteristics, technical success, safety, and cost effectiveness.
Aim and Objectives of the study: The objective of the study to compare the outcomes of Choledochoduodenostomy (CDD) versus choledocholithotomy and insertion of a T-tube in subjects with multiple CBD stones.
Methodology: This study was conducted in the Dept. of Surgery, Tripura Medical College. we included a total of 60 subjects divided into two groups, Group A and Group B with 30 subjects in each group. Group A underwent choledocholithotomy and insertion of a T-tube and Group B underwent Choledochoduodenostomy. Details of the study were told to the patient and informed consent was taken. After obtaining consent, the patient underwent procedure as per the study design. We compared the parameters, mean operating time (minutes), mean duration of stay at hospital (days), frequency of wound infection and post-operative serum bilirubin.
Results: We compared mean operating time (minutes), mean duration of stay at hospital (days), frequency of wound infection and post-operative serum bilirubin between the two groups. The Mean operating time (minutes), mean duration of stay at hospital (days), frequency of wound infection and post-operative serum bilirubin in Group A were 68 ± 11.8, 8 ± 1.82, 11% and 0.78 ± 0.33 in Group B were 98.6 ± 10.1, 14 ± 3.21, 26% and 1.7 ± 0.97 respectively. There was statistically significant difference in all the parameters between the two groups.
Conclusion: Both Choledochoduodenostomy and T-tube drainage after CBD exploration are equally good procedures for the treatment of uncomplicated choledocholithiasis. However, choledocolithotomy and insertion of a T-tube is having significantly lower operating time and
less duration of stay at hospital. Therefore, it can be recommended for treatment in selective patients of choledocholithiasis.
 

Assessment of the efficacy of Magnetic Resonance Cholangiopancreatography (MRCP) and Ultrasonography (USG) in detection and characterization in patients suspected with pancreatic and biliary disorder: A comparative study

Dr. Sneha Choudhary; Dr. Gurshaan Singh Makkar; Dr.Deepanshu Suhag; Dr. Shagun Sain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 1836-1841

Aim: To compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in evaluation of patients with obstructive jaundice.

Comparative assessment to establish the accuracy of MRCP over USG & CT in diagnosing the case of obstructive jaundice

Dr. Sahil Chawla, Dr. Monika Sharma, Dr. Aastha Makkar,Dr. Naresh Tripathi, Dr. Pratibha Gupta, Dr. Naveen Pahal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 1113-1118

Aim: To compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography
(MRCP) with Ultrasound and Computed Tomography (CT) in evaluation of patients with
obstructive jaundice.
Methodology: This study was conducted in the Department of Radio Diagnosis, Maharishi
Markandeshwar Medical College and Hospital, Kumarhatti, Solan for the period of 6 months.
60 patients clinically diagnosed as suffering from obstructive jaundice and having total
Bilirubin greater than 5mg/dl were included in this study. Patients who were pregnant and
claustrophobic were not included in this study. All the patients were instructed to fast
overnight prior to examination. Renal functional status, clinical history of all the patients was
noted before undergoing contrast CT. All the patients in the study underwent USG
examination first followed by MRCP and finally CT. Both curvilinear and linear probes were
used in the study. Images of the biliary tree were recorded for later review. Helical CT was
performed on a Philips Healthcare 128 slice CT scanner. MRCP was performed on Philips
Healthcare 1.5 Tesla MRI Scanner. All images were obtained with breath holding and
parameters were individualized.
Results: Of 60 patients, 16 (26.7%) patients were ≤45 years and 44 (73.3%) were >45 years.
32 (53.3%) cases were males and 28 (46.7%) were females. There were 37 (61.7%) patients
with ≤40 days of duration of symptoms and 23 (38.3%) patients with >40 days of duration of
symptoms. In causes of obstruction, choledocholothiasis was responsible
for19(31.7%),stricture16(26.7%),carcinoma ofheadofpancreas11(18.3%),
gallbladdercarcinoma6 (10%), periampullary carcinoma5(8.3%) and cholangiocarcinoma in 3
(5%) of the cases. Taking MRCP as gold standard, 100% (60 cases) had obstructive jaundice.
Whereas 56.7% (34 cases) were diagnosed correctly using USG and 86.7% (52 cases) were
diagnosed correctly using CT. The sensitivity of MRCP is 94% and CT is 92%, while it is
100% for USG. Inspite of the high sensitivity for USG, the specificity for the same is very
low at 70% when compared to that of CT’s 72% and MRCP’s 100%.
Conclusion: The only drawback of MRCP is the cost involved and the availability. From this
study, It is recommended that helical CT can be used as a screening imaging technique to
identify the presence or absence of intrahepatic biliary duct dilatation; thereby shortlisting the
patients for MRCP examination.