Open Common Bile Duct Exploration in a Nigerian Tertiary Hospital
Adewale Adisa, Olusegun Alatise, Olalekan Olasehinde, Bolanle Ibitoye, Olukayode Arowolo, Oladejo Lawal
Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
Correspondence to: Dr Adewale O. Adisa. Department of Surgery, Obafemi Awolowo University, Ile-Ife,
220005, Osun State, Nigeria.
Background: The prevalence of extra-hepatic biliary stones in Nigeria is unknown and its treatment frequently undocumented. We have observed an increase in bile duct exploration in our hospital. Methods: This is an eight-year retrospective report on consecutive patients who underwent common bile duct exploration. The diagnosis, pre-operative preparation, intra-operative findings and post-operative outcome were documented. Results: Forty-one patients were explored; 33 females (80.5%) and 8 (19.5%) males. Four had sickle cell anaemia. Pre-operative ultrasound showed common duct dilatation in 36 (87.8%), and choledocholithiasis in 29 (70.7%). Six patients did abdominal CT, 2 MRCP and none ERCP. Choledocholithiasis was operatively confirmed in 39 (95.1%) and dilated CBD without stones in 2. T-tube was inserted in 17 (41.5%) and primary closure of the common duct was done in 24 (58.5%). The mean duration of operation (102 vs 184 minutes) and hospital stay (10.6 vs 14.4 days) were less with primary closure. Conclusion: Common bile duct exploration is increasingly being performed in our center with a good outcome. There is increasing adoption of primary closure of the common bile duct in our setting.
Keywords: Common bile duct, T- tube Ann Afr Surg. 2018; 15(2):62-67
© 2018 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.
Conflicts of Interest: None
The prevalence of gallstone disease would appear low in Nigeria; population based studies are lacking though. Some reports of peculiar patient cohorts have reported 3% in pregnant Nigerian women (1), 17% in Nigerians with type 2 diabetes mellitus (2) and up to 24% among patients with sickle cell diseases (3). Presentation of choledocholithiasis and its treatment is scantily documented in Nigeria however, studies reporting on treatment and outcome of obstructive jaundice have highlighted varying prevalence of choledocholithiasis among different subsets of patients across Nigeria (4,5). Current recommended treatment of common bile duct stones include endoscopic extraction with endoscopic retrograde cholangio-pancreatography (ERCP) as well as laparoscopic or open duct exploration and stone retrieval (6). Recent studies have affirmed the comparability of stone clearance with laparoscopic exploration compared to preoperative, intraoperative or postoperative ERCP (7,8) Open exploration is now reserved for the difficult or failed endoscopic extraction and conversions during laparoscopic attempts. In our hospital, ERCP is not yet routinely performed and the laparoscopic approach is yet to be reported in any center in Nigeria with open retrieval being the most commonly adopted treatment for common bile duct stones. This study was carried out in two general surgery units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria to review the indications, procedures and outcome of common bile duct exploration in patients presenting with choledocholithiasis in our hospital with the aim of highlighting temporal changes in the practice.