A patient having multiple Gall stones and shows 8 mm dilation and 4 stones in CBD, best treatment modalities are -: (A) Cholecystectomy with choledocholithotomy at same setting, (B) ESWL, (C) Cholecystectomy and wait for ERCP, (D) All
Answer is A. Answer (a) Cholecystectomy with choledocholithotomy done at same sitting Management of suspected or proven CBD stones associated with gall bladder stones For gallstones - laparoscopic cholecystectomy is the procedure of choice. For CBD stones two things can be done: 1) If the surgeon is experienced in laparoscopic techniques of CBD stone removal then both cholecystectomy and choledocholithotomy is done in the same sitting. - CBD stones are first confirmed by an intraoperative cholangiogram - then the stones are removed laparoscopically the cystic duct or by choledochotomy. 2) If the surgeon is not experienced with laparoscopic methods of CBD stone removal, preoperative endoscopic sphincterotomy with stone removal and later laparoscopic cholecystectomy is done. Laparoscopic cholecystectomy with choledocholithotomy in the same sitting is the preferred technique (provided the surgeon is experienced) But one must keep in mind here that "for elderly, poor-risk patients with gallstones and CBD stones some have recommended ERCP and sphincterotomy as the sole treatment, leaving gallbladder and stones in situ". - Maingot's 10/e Usually the gallstones in these patients remain asymptomatic and if need arises can be managed by cholecystectomy