Surgical Treatment of Bile Duct Stones after Failed Endoscopic Management

Abstract

Background: Bile duct calculi occur in a significant proportion of patients with cholelithiasis. They are usually managed by endoscopic methods, but surgical management is needed in complicated cases. The choice of a specific surgical procedure depends on various factors, such as the extent of bile duct dilation, the location of stones, and the presence of stricture or fistula. In this study, we described the different surgical procedures and their outcomes for patients with bile duct stones that could not be cleared by endoscopic methods.
Methods: This is a retrospective cross-sectional study of patients who underwent different surgical procedures for bile duct stones. Patients treated from January 2022 to December 2024 were included in the study. Demographic and clinical data were obtained from medical records and analyzed.
Results: There were 55 patients, of whom 36 were female. Pain in the abdomen and jaundice were the most common symptoms. Laparoscopic common bile duct exploration was done in 10 (18.2%) patients. Bile duct stones along with biliary fistulas, hepatolithiasis, or liver atrophy were present in 16(29.1%) cases. Besides bile duct exploration, other procedures, including choledochoduodenostomy or hepaticojejunostomy(14.5% ), choledochoplasty (5.5%), and liver resection (12.7%), were required for the management of these patients. There was no mortality, but two (3.6%) patients had residual stones, and eight (14.5%) patients developed major complications with Clavien-Dindo grade three or more.
Conclusions: Bile duct calculi that could not be cleared by endoscopic methods require surgical intervention. CBD exploration in combination of other required procedures can be performed for the management of bile duct stones and their complications with good outcomes.
Keywords: Bile duct; bile duct exploration; cholelithiasis, choledocholithiasis; hepatolithiasis.