الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
In 10 to 15 percent of individuals having surgery for symptomatic cholelithiasis, common bile duct (CBD) stones are found. To prevent complications including acute suppurative cholangitis, obstructive jaundice, hepatic abscess, and acute pancreatitis, CBD stones must be extracted. Any one clinical factor cannot reliably predict choledocholithiasis.
A comprehensive history and physical examination, lab tests, and diagnostic imaging methods must all be taken into account in order to identify whether a patient has CBD stones. Traditionally, intraoperative cholangiography was used to diagnose CBD stones and open CBD exploration was used to cure them. The diagnosis of CBD stones is now easier with to advancements in preoperative imaging technology including abdominal MSCT, ERCP, MRCP, and EUS.
There are different methods for management of CBD . our study done for patients with CBD stones which ERCP failed to extract the stones from CBD.
This current study included 30 patiens with CBD stones with failed ERCP to exetract the stones and they had been devided into two groups each one include 15 patients :
group (A):- patients underwent T tube drainage after choledocholithotomy.
group (B):- patients underwent intraoperative CBD stenting after choledocholithotomy.
In this study we found that intraoperative CBD stenting after choledocholithotomy is better than T tube drainage with shorter hospital stay ,wound infection ,good biliary drainage from CBD to the duodenum with less liability for postoperative bile leakage ,equivelant operation time and mortality rate.
Two procedures can be done by laparoscopic or open surgery but cases of intraoperative CBD stenting preferred to be done by open surgery as the distal end of the stent should be palpated in the duodenum to confirm that it is in the true position to prevent its proximal migration and facilitate its distal migration postoperative to minimize ERCP use for postoperative stent removal.For this we support the use of intraoperative biliary stent for biliary decompression after CBD exceploration and stone exetraction.