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Management of gallstones in a district general hospital
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Surgery for benign biliary disease has low mortality, but complications are common. Common bile duct exploration increases complication and mortality risks, especially in elderly patients with sepsis undergoing multiple procedures.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Benign biliary disease encompasses a range of conditions affecting the gallbladder and bile ducts.
- Surgical intervention is often necessary for managing symptomatic benign biliary pathology.
- Complications and mortality associated with biliary surgery necessitate careful patient selection and procedural planning.
Purpose of the Study:
- To review surgical outcomes for benign biliary disease.
- To identify risk factors for complications and mortality.
- To evaluate the safety and efficacy of common bile duct exploration techniques.
Main Methods:
- Retrospective review of 815 consecutive patients undergoing surgery for benign biliary disease.
- Analysis of operative outcomes, including mortality, complications, and residual calculi.
- Stratification of risk based on patient demographics, surgical procedures, and clinical presentation.
Main Results:
- Overall mortality was 0.7%, with no deaths in elective operations.
- One-third of patients experienced complications.
- Common bile duct exploration (n=160) had a 2.5% mortality and 46% complication rate.
- Residual calculi were found in 7.4% (7/95) of patients after duct exploration and cholangiography.
- High-risk group for choledocholithiasis: elderly, emergency surgery for sepsis, multiple duct procedures (10% mortality).
Conclusions:
- Surgery for benign biliary disease is generally safe with low mortality.
- Common bile duct exploration is associated with increased morbidity and mortality.
- Prompt identification and management of residual calculi are crucial.
- Elderly patients with sepsis undergoing emergency surgery and multiple duct procedures represent a high-risk group for choledocholithiasis.
Abstract:
This survey reviews 815 consecutive patients undergoing surgery for benign biliary disease. There were no deaths following elective operations and the overall mortality was 0.7 per cent. One-third of patients had one or more complications. The mortality in patients having common bile duct exploration (n = 160) by one or more methods was 2.5 per cent (4 patients) with 46 per cent of these patients having complications. Of 95 patients undergoing duct exploration and postoperative T-tube cholangiography, 7 had unexpected residual calculi after initial cholecystectomy. Five have had further surgery to clear the duct. All patients having duct surgery alone for retained stones (n = 24) had previously had cholecystectomy with or without supraduodenal duct exploration. Of all patients undergoing choledochoduodenostomy or transduodenal sphincter exploration only one has returned with evidence of retained calculi. Patients with choledocholithiasis were examined in an attempt to identify a high risk group. These were found to be elderly patients, having emergency surgery for sepsis and on whom more than one duct procedure was performed (mortality 10 per cent).