Surgical Management of Common Bile Duct Stones at Saint Paul’s Hospital, Addis Ababa, Ethiopia

Background: This study was aimed at evaluating the trend and outcome of surgical management of choledocholithiasis in St. Paul Teaching Hospital Addis Ababa, Ethiopia.
Methods: This was a clinical based retrospective analysis. The operation register was used to identify the cases that were operated for biliary lithiasis. Their clinical records were obtained from the record office of the hospital and data collected and recorded on a predesigned format. Data was analyzed by SPSS statistical software. Pearson’s chi-square test was used for statistical analysis. P-value < 0.05 was considered significant.
Results: A total of 1230 underwent open cholecystectomy over 5 year period of which 98 patients where found to have choledocholithiasis constituting 7%. Of the 98 patients who underwent common bile duct (CBD) exploration, the records of 78 patients were found and made the basis of this analysis. Fifty-nine (75.6%) patients were females and 19(24.4%) were males, with a male to female ratio 1: 3. The mean age was 49.15 years. The most common symptoms were right upper quadrant pain and jaundice. The most frequent physical findings was right upper quadrant tenderness. Choledocholithotomy with T-tube insertion was done in 39 patients, side to side choledochoduodenostomy in 34 patients, and hepaticojejunostomy in 5 patients. Twenty-four (71.6%) choledochoduodenostomy patients were discharged in less than ten days after operation while 36(87.1%) of those with T-tube were discharged after 10 days (p<0.019). The re-operation rate was 12.8% for the T-tube insertion group and 2.9% for choledochoduodenostomy patients. There were 3(8.8%) deaths in the former and 1(2.9%) in the group of choledochoduodenostomy. The overall complication rate was 11 (30.6%) for the T-tube insertion and 3 (8.8%) for the choledochoduodenostomies.
Conclusion: Choledochoduodenostomy is a better option than Choledocholithotomy with T-tube insertion in the treatment of choledocholithiasis in African setting. We recommend choledochoduodenostomy (CD) for multiple CBD calculi, big calculi in the CBD, much dilated CBD (>2cm), primary CBD stones, hepatic stones, recurrent stones, and elderly patients where the size of the CBD is 15mm and above.