Comparative outcome in biliary stone management in Mukdahan hospital

Abstract

Objective: To compare the results of open surgery and minimally invasive surgery in patients with biliary stones admitted at Mukdahan Hospital.

Material and method: This was a retrospective descriptive study conducted on the patients who received treatment and surgery for biliary stones at Mukdahan Hospital from 1^st July 2020 to 31^st March 2022.

Results: A total of 378 patients were included in the study of which 151 (40.0%) were males and 227 (60.0%) were females. The mean age of the patients was 57.31 years. Altogether there were 412 surgeries such that 32 patients were operated on twice and a patient had three surgeries. The mortality and referral rates were 4 (1.1%) and 2 (0.5%), respectively. The number of patients who underwent laparoscopic cholecystectomy (LC) was 155 (37.6%), that of open cholecystectomy (OC) was 129 (31.3%), OC with common bile duct (CBD) exploration and T-tube insertion was performed in 25 (6.1%), 27 (6.6%) had OC with CBD exploration and a choledochoduodenostomy, and those who had endoscopic retrograde cholangiopancreatography (ERCP) and stone extraction were 77 (18.7%). Overall, 243 (59%) patients underwent urgent surgeries and 169 (41%) had scheduled surgeries.

Out of 284 patients with gallbladder stones, 155 (54.6%) were surgically treated by LC, and 129 (45.4%) underwent OC surgery. The operative time was statistically insignificant between the LC and OC procedures (p=0.09) but significantly less blood loss, postoperative hospital stay and pain at 24 and 48 hours (p < 0.01), and complications (p=0.03) were recorded in the patients who had LC. About 4% (6 patients) who had LC surgery underwent conversion to other procedures. Furthermore, bile duct injury was found in 6 (2.7%) patients and CBD stones recurrence in 7 (2.46%) patients.

A group of 116 patients underwent surgery for CBD stones along with gallstones in the study. The adverse event rate and stone clearance rate between CBD exploration and ERCP were not significantly different (38.4% vs 23.4%, p=0.06 and 72% vs 84.4%, p=0.40, respectively). However, blood loss, surgery duration, postoperative hospital stay, and pain were significantly less in ERCP than in the CBD exploration procedure (p < 0.01).

A total of 25 patients had a T-tube cholangiogram, and 7 were revealed to have retained CBD stones. Out of 6 patients who underwent successful ERCP, one failed and was referred to Sapphasitthiprasong Hospital. Moreover, 12 patients failed ERCP, of which 2 patients were converted to OC, 6 underwent re-ERCP, 1 was referred, 1 received antibiotics, and 2 died during the study period.

Conclusions: The study found that the postoperative pain and stay in the hospital, and blood loss during both laparoscopic and ERCP minimally invasive biliary tract surgery were less than the open surgery. However, the treatment outcomes were not different. Open surgery is necessary in cases where laparoscopic surgery is not possible or laparoscopic surgery is unsuccessful. The treating physician should choose a surgical treatment that is suitable for each patient under different constraints.