Retrospective Comparative Analysis of Open Bile Duct Exploration Versus ERCP for Treat Bile Duct Stones with Acute Cholangitis in Mukdahan Thailand
Keywords:
Biliary duct stones,, Biliary duct stone surgery,, Biliary tract infection,, Biliary pancreatic endoscopyAbstract
Background: Patients with biliary system infections caused by bile duct stones require surgery to alleviate obstruction, prevent complications such as sepsis or liver damage, and restore normal bile flow. Early and proper surgical intervention, such as endoscopic or open bile duct surgery, significantly improves patient outcomes and reduces the chance of recurrent infections.
Objectives: To compare the results of open bile duct exploration and endoscopic retrograde cholangiopancreatography (ERCP) in patients admitted to Mukdahan Hospital with acute cholangitis with common bile duct stones.
Materials and Methods: This was a retrospective descriptive study. The population studied were patients who were admitted to Mukdahan Hospital with acute cholangitis, and common bile duct stones and underwent surgery at Mukdahan Hospital during the period of 1 July 2020 – 31 July 2022.
Results: (1) In This retrospective study a total of 250 patients were included in the study. Patient characteristics of the study were not different, except ASA classification and cholangitis grading. In 125(50%) patients underwent treatment by open bile duct exploration (CBDE) and 125(50%) patients underwent treatment by endoscopic retrograde cholangiopancreatography (ERCP). (2) The outcome of treatment acute cholangitis from CBD stone by ERCP and open bile duct exploration There were no significant differences in the clearance (92.8% vs. 88.0%, p = 0.54) and hospital mortality (1.6% vs. 1.6%, p = 0.56) However, blood loss, surgery duration, postoperative hospital stay, and pain were significantly less in ERCP than in the CBD exploration procedure (p < 0.01). (3) In postoperative complication the study found Postoperative bile leak, post-operative Pneumonia, post-operative AKI, and Sepsis common in the CBD exploration group and post-operative Pancreatitis common in the ERCP group.
Conclusion: The study found that the outcome of treatment acute cholangitis from CBD stone by ERCP and open bile duct exploration were not different but the postoperative pain and stay in the hospital, blood loss, and post-operative complication in ERCP were significantly less than open bile duct exploration.
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