APPRAISAL OF SURGICAL AND ENDOSCOPIC MANAGEMENT OF CHOLEDOCHOLITHIASIS

One hundred and ten patients with common bile duct (CBD) stones were t reated in the Department of Surgical Gastroenterology at SGPGIMS, Luck now, India between January 1989 and December 1992. The primary modalit y of treatment was surgery in 62 patients (group I) and endoscopic sph incterotomy (ES) in 48 (group II). The two groups were well matched wi th respect to clinical features and presence of medical risk factors. Surgical clearance of CBD stones was achieved in 58 patients (93.5%; g roup Ia). Four patients (7%) had retained stones following surgery (gr oup Ib). In group II, the CBD was cleared by endoscopic means in 20 ou t of 48 patients (42%) and was categorized into group IIa. In the rema ining patients ES was followed by CBD exploration (group IIb). Signifi cantly higher morbidity was seen in patients needing CBD surgery follo wing attempted endoscopic clearance, because of ES-related complicatio ns, such as bleeding, cholangitis, septicaemia and numerous others. Us e of ES to treat CBD stones on a routine basis was therefore not found to be any better than one-time surgical exploration.