Question

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 the same setting
• B. ESWL
• C. Cholecystectomy and wait for ERCP
• D. All

Answer 1

The Correct Option is A

A patient with multiple gallstones and a dilated common bile duct (CBD) measuring 8 mm with 4 stones present in the CBD requires an effective treatment strategy to address both the gallstones and CBD stones. The most appropriate management in this scenario is:

• Cholecystectomy with choledocholithotomy at the same setting

Explanation:

1. The presence of multiple gallstones warrants a cholecystectomy, which is the surgical removal of the gallbladder, to prevent future complications such as cholecystitis or pancreatitis.

2. The CBD stones require removal to prevent obstruction, which can result in jaundice or cholangitis. A choledocholithotomy involves surgically opening the CBD to extract the stones.

3. Performing both procedures in the same setting is advantageous as it allows for the immediate resolution of both the gallstones and CBD stones, reducing the risk of recurrent symptoms and the need for additional procedures.

4. While endoscopic retrograde cholangiopancreatography (ERCP) can also be utilized for CBD stones, addressing the gallbladder and CBD stones in one surgical session is optimal in this case due to the multiple stones present.

Therefore, the indicated treatment modality is to perform a cholecystectomy with choledocholithotomy simultaneously, ensuring comprehensive management with a single intervention.