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Choledocolithiasis About 272 cases treated CHN Nouakchott – Mauritania Moulaye Driss A, Lehbib Md.S Abdllatif M., B. Moctar, B. Hamad, Mahfoudh M.V,B.Taleb, A.B. Nacereddine, S.Mogueya and all.

Purpose : The authors report a retrospective descriptive study of 272 cases of gallstones in the common bile duct (choledocholithiasis). The purpose of the study is to evaluate the treatment and epidemiological profile of CBDS encountered a surgical clinic of the National Hospital Center of Nouakchott in Mauritania.

Africa

Europe

Our study

Frequency:

2% Koffi (C. Ivoire)

8-15% JC Berthou (France)

10% (Mauritania)

Mean age:

46 ans Koffi (C. Ivoire)

64 ans (JC. Berthou) Parfois 74ans en Europe

53 ans (Mauritania)

Sex/ratio: W/M

2.3/1 Koffi (C. Ivoire)

3/1 JC Berthou (France)

6/1 (Mauritania)

Patients and methods: Over a period of five years (January 2007-December 2012) in a single institution 1409 patients underwent cholecystectomy. The criteria for inclusion are all operated patients with lithiasis of the CBD. Were excluded all cases of cholelithiasis without CBD stones, all acalculous cholecystitis and all patients operated outside department. 272 files records were compiled. The variables studied were: age, gender, ethnicity, history, clinical, Biology, US, CT- Scan, type of intervention, route first, and the postoperative length of stay. The databases have been studied and analyzed statistically by the SPSS system. Results: There were 230Women and 38Men, the average age was 53.6y (15-88y). The Moorish ethnicity is dominant (95.6%). There were 36(13.2%) cases with history of cholecystectomy, 14(5.1%) diabetic 8(2.9%) hypertension and 4 cases of sickle cell patients. Clinically 130 (48%) cases RUC pain with jaundice, while the isolated pain was observed 122(44.8%) cases and cholangitis 10 (3.7%) cases. Biologically the chole stasis was confirmed in 162 (49%) cases, leukocytosis was found in 49 patients (18%) and cytolysis in 32 (11.8%) cases. 254 patients underwent ultrasound (93.4%), The CT-Scann in 141 cases (51.5%) and was contributing in 108 (39.7%) cases. The Bil-MRI was performed in 12 patients. The operative risk was 1.4% with 3 cases of ASA III and 1 case of ASA IV. The Interventions are a cholecystectomy in all cases, with a choledocostomy by Kehr tube in 196 (72.1%) patients. The biliodigestive bypass was performed in 48 (17.6%) patients and with choledocotomy ideal suture in 2 patients. The mortality rate was 2.9%. Complications occurred in 58(21.3%) patients and were mainly infectious in 42(15.4%) cases, 6 cases (2.2%) of residual calculi, and 2 cases of hematoma. The average length of hospital stay was 15.97days with extreme (2-29 days). Six patients underwent sphincteretotomy and 4cases of sickle cell patients.

Techniques Choledocost. 72% DBD

18%

Discussion The stones in the common bile duct (CBC) remains the subject of controversy regarding its diagnosis and especially its treatment. If there is a consensus to operate immediately a gallstone, unanimity is not made as to the laparoscopic treatment of cholelithiasis. While in developed countries, it can be treated completely laparoscopically (1) in our country, its treatment remains for the time being "traditional", ie entirely led by laparotomy.

Suture ideale 0.7%

Literature

Our study

Mortality

0 – 5%

2.9%

Morbidity

8 – 20%

21.3%

Conclusion: Cholelithiasis is common in Mauritania and CBDS rate is high. Our results are satisfactory despite the weakness of the technical platform and stage presentation. We suggest in our institution a systematic cholecystectomy because of the high cost and supported in our conditions.

Biblio 1-BERTHOU JC, DROUARD F, PASSON-SZERZYNA N. Traitement coelioscopique de la lithiase de la voie biliaire principale. Encycl Med Chir, Techniques chirurgicales - Appareil digestif, 40- 952, 1995, 14p. 2- BOUVET B, BRETTE R. Symptômes et complications de la lithiase. Encycl Med Chir (Paris). Foie Pancréas 1987, 7047 B10, 10p 3- KOFFI E, YENON K, EHUA S, COULIBALY A, KOUASSI JC, KANGA M. La lithiase de la voie biliaire principale en milieu ivoirien. Méd Afr Noire 1999 ; 46(2) : 114-118.