INTEGRATED MANAGEMENT OF COMPLICATED GALLBLADDER DISEASE AND COMMON BILE DUCT STONES: ROLE OF MRCP, ERCP, T-TUBE DRAINAGE, AND CHOLEDOCHODUODENOSTOMY IN A COMBINED 41 PATIENT COHORT

Abstract

Background: Management of complicated gallbladder disease and choledocholithiasis requires appropriate use of non-invasive imaging, therapeutic endoscopy, and surgery. MRCP provides non- invasive assessment of the biliary tree, whereas ERCP is principally therapeutic. Open common bile duct (CBD) exploration with T-tube drainage or choledochoduodenostomy (CDD) remains relevant in selected difficult cases. Methods: Total of 41  patients. Cohort 1  comprised 29 patients who underwent open CBD exploration. MRCP was performed in all 29 patients within one surgical cohort, Group A included 14 patients treated by choledochotomy with T tube drainage and Group B included 1 5 patients treated by choledochoduodenostomy. Cohort 2 comprised 12 patients with difficult/complicated gallbladder disease managed with individualized combinations of laparoscopic cholecystectomy, MRCP/CECT, ERCP and stenting, percutaneous drainage, conservative management, or open CBD exploration. The two cohorts were combined descriptively; percentages, mean, standard deviation were used . Results: Of the total 41  patients, 29 (70.73%) belonged to the CBD-exploration cohort and 12 (29.27%) to the complicated-gallbladder cohort. In the 29-patient surgical cohort, T-tube drainage was performed in 14 (48.28% of that cohort; 34.15% of the combined cohort) and CDD in 15 (51  .72% of that cohort; 36.59% of the combined cohort). The  29-patient dataset reported cholelithiasis with choledocholithiasis in 18 (62.06%), CBD stricture in 5 (17.24%), Mirizzi syndrome in 4 (13.79%), pancreatitis in 2 (6.90%), and previous ERCP with CBD stent in situ in 2 (6.90%). The 12-patient difficult- gallbladder series demonstrated selective use of preoperative ERCP when MRCP confirmed CBD stones and postoperative ERCP/stenting for selected biliary complications or persistent biochemical/clinical obstruction. Conclusion: The 41-patient experience conculded the indication-based approach. MRCP is useful for non-invasive diagnostic clarification and biliary mapping, ERCP is reserved mainly for therapeutic duct clearance or decompression, and surgery remains important for impacted or complex stones, benign distal obstruction, failed endoscopic management, or difficult operative anatomy. Because the two  cohorts differ in design, indication, and treatment pathway, the merged analysis is descriptive and should not be interpreted as a randomized or head-to-head comparison of MRCP, ERCP, T-tube drainage, and CDD.