Fifty patients with calcular obstructive jaundice. 32 were females and
18 are males. Their ages ranged between 32-70 years diagnosis was
Achi^ved after proper clinical assessment, full set of laboratory investiga
Tions., abdominal ultrasongraphy, and diagnostic e.R.C.P. Then, the pa
Tients were randomized without any specifications into two equal groups:
A and b. Patients belonging to group (a) were managed by the tradition
Al open surgical procedure, while management of group b patients were
Attempted by endoscopic sphincterotomy and stone extraction followed
Two weeks later by laparoscopic cholecystectomy. In group (bl patients.
Ajter\ overcoming the different endoscopic difficulties encountered, complete,
C..B.D clearance was achieved in 23 patients (92%) with two compli
Cations, (8%) bleeding in one patient managed endoscopically and pan
Creatitis in another one managed conservatively: the failed two cases
(8%) were managed by open surgery.•
Laparoscopic cholecystectomy was attempted only in the 23 patients
With ^uccessful endoscopic c.B.D clearance. The difficulties encountered
Were \ related to insufflation, dissection, control of bleeding, spillage of
Stones, and extraction of stone-loden gall bladder. The procedure. Sueceeded in 19 patients (82.6%) and the remaining 4 were converted to
Open surgery. Evaluation of the results, as regard morbidity, mortality,
Hospital stay and cost. The results of follow up of both groups which
Started since the beginning of the study till 6 months after the last case.
It is considered that minimally invasive procedures had definitive ad
Vantages over the traditional management. Significant differences were
Noted as the operative time; postoperative pain, postoperative ileus, re
Quirements for antibiotics, requirements for drainage, t-tubes, and nasogastric
Suction, postoperative hospital stay, and postoperative morbidity
And mortality. Furthermore, the routine endoscopic relief offaundice prior
To surgery has offered protection against the most serious complications
Of calcular obstructive faundice namely hepatorenal failure and septicemia |
