Bile Duct stone operation, unsatisfactory results

[NewGuy]

In a Chonburi province hospital (I don’t want to bring revenge my way), I spoke to a doctor about me waking up every 5-8 days with a very painful sensation at the top of my stomach. My stomach felt rigid. After a few hours the pain went away but it shook me up for a day or so.. This happened 5 or 6 times before I went to the hospital. There was a lot of probing, scanning, with a preliminary diagnosis that i had a bile duct stone.

 

After an MRI and two days wait they operated on me. A tube with tools was put down my throat. Result: some small stones were removed/excreted but the large one which was causing the problem was too hard to break. A plastic stent was put around the stone; the stent is expected to last 2 months, the tube was removed.

 

The surgeon told me he’d had cases where they did the procedure one or two additional times. If those didn’t work there would either be an incision in the stomach; there could also be micro surgery. He said the latter options weren’t for me given the state of my heart. 79 years old, afib controlled by drugs, diabetes and lots more. When my heart guy was giving me a post op ekg he whacked me on the chest. My heart had stopped for 3 seconds.

 

in addition, one of the doctors was quite jovial grabbing the flesh down the middle of my stomach. - he said hiatus heria and laughed.

 

Back home.just now I feel shaky and my wife is pulling, lifting, half carrying around. The insurance bill of 370,000 was just approved.

 

Please Sheryl and others experienced let me have your thoughts.

 

Cheers
 

 

[NewGuy]

Hernia of course. I was given two week supply of GraCEvit(Sitafloxacin) 50 mg and Ursolin cap 250 mg.

 

big ps, i was supposed tofly to Canada for 2 months; I’ll try to change that to 7 weeks and stay home for a while.

[Ben Zioner]

Did you have a Cholecystectomy prior to these stones stuck in the bile ducts?

[NewGuy]

No, I didn’t have any gallbladder removal.)

[Ben Zioner]

39 minutes ago, NewGuy said:

No, I didn’t have any gallbladder removal.)

Did they tell you if you have any stones in your gallbladder? I had mine removed a couple of months ago, it is a very minor operation. I would have thought they'd consider it to prevent any further issue.

 

 

Edited June 25 by Ben Zioner

[Sheryl]

I am not clear what s the status now? Stent still in place, or removed? Are you still having the attacks of abdominal pain?

 

Gall bladder removal is indeed recommended in a case like this but not until after the bile duct stone has been removed and patient recovered from that. I would suggest OP see about doing that in Canada.

 

They have to get that stone out, it is essential. The stent is just a temporary fix.

 

There are methods other than surgery for getting out a large bile duct stone,  but not available at all hospitals:

 

 Mechanical lithotripsy:  breaking up a larger bile duct stone by capturing it and then crushing it in a wire “basket” that is inserted through the endoscope. Once the stones are crushed, they are removed using special tools through the endoscope.

 

Intraductal electrohydraulic lithotripsy: a very fine probe is inserted through a tiny scope that is passed through the ERCP endoscope. The probe, which is connected to a generator, provides a shock wave that breaks up the stone. Once the stones are crushed, they are removed using special tools through the endoscope.

 

Both of the above are done with the same endoscope passed through the mouth that you just experienced, but additional equipment is needed to then break up the stone so that it can be removed.

 

In  Thailand, I know they have this at Chulalongkhorn.  I am not sure if any of the private hopsitals have it. You might try messaging Bangkok Hospital (Bangkok branch), MedPark, Bumrungrad and Samitvej (Sukhumvit branch) and asking them if the have capacity to do "ERCP with mechanical lithotripsy to remove very large bile duct stone".  If you find one that can, let me know and I'll suggest a doctor.

 

Or, you could go straight to Chula but that means really long waits and crowds to see the doctor, may be hard in your present state. If you go that route,  use their "special medical clinic" after hours route and this is the man you want

  https://spcweb.kcmh.or.th/users/users/getDoctorClinic/31ceadb76fc9937a40b229367d199d0a-010333-

 

Prof. Phontep Angsuwacharakorn.

 

He is only there on Fridays. You call  02-256-5193  to make appointment. They will give you a confirmation code, write it down as you need to show it when you register on first floor. If they try to give you an appointment in the far future, pleading urgency often works.

[NewGuy]

Thank you Sheryl. A lot to take in as I’m going half-speed. To clarify. I we went to the hospital this past Friday, they went down my throat on Sunday, I was released Tuesday (yesterday late) and posted that same evening. I have had the stent for 4 days now. I will make those calls this morning and update this thread.

 

How urgent is my situation? Should I get the operation in the next six weeks or so? If it is safe for me to get it only on my return from Toronto 8 weeks hence; the trip is a nice-to-do, not essential. 
 

Cheers

[BigStar]

Not clear what the reason is for all the dissatisfaction. Did you expect instant results? Seems the doc knows what he's doing.

[Sheryl]

4 hours ago, NewGuy said:

Thank you Sheryl. A lot to take in as I’m going half-speed. To clarify. I we went to the hospital this past Friday, they went down my throat on Sunday, I was released Tuesday (yesterday late) and posted that same evening. I have had the stent for 4 days now. I will make those calls this morning and update this thread.

 

How urgent is my situation? Should I get the operation in the next six weeks or so? If it is safe for me to get it only on my return from Toronto 8 weeks hence; the trip is a nice-to-do, not essential. 
 

Cheers

It is  pretty urgent to get that stone out as soon as you are recovered and physically stable enough to undergo the procedure.  The stent  could fail at any point and then it is a critical situation. 

 

Subsequent gall bladder removal is necessary but no rush. The stones that caused this mayhem came from you gall bladder. (Don't however do that in the provinces. With your cardiac history need to be in top notch hands). 

 

 

 

 

 

[Sheryl]

1 hour ago, BigStar said:

Not clear what the reason is for all the dissatisfaction. Did you expect instant results? Seems the doc knows what he's doing.

 

Normally results would be immediate. 

 

Unfortunately in his case, one of the obstructing stones was huge and could not be removed without additional equipment most hospitals lack. The doctors did the correct thing in that situation by inserting a stent  but failed to inform him that there are non-surgical options in at least one Bangkok hospital for getting the stone out. 

 

 So understandably described as an unsatisfactory result.  His bile duct is still blocked by a large stone  with just a temporary fix in place. 

 

Also unfortunately in his case, he suffered some (hopefully temporary) cardiac complications  from the stress of the procedure and, possibly, the anesthetic if one was used. 

[Sheryl]

22 hours ago, NewGuy said:

Hernia of course. I was given two week supply of GraCEvit(Sitafloxacin) 50 mg and Ursolin cap 250 mg.

 

 

Neither of these meds relate to your hiatal hernia.

 

The Sitafloxacin is an antibiotic.  The Ursolin is a drug to dissolve bile stones. This drug,  if it works at all    takes months to years to do so. It is highly unlikely to do anything for the large stone obstructing your bile duct but may help prevent new stone formation in the gall bladder. 

 

For hiatal hernia, best management  is weight loss, sleeping with head elevated, and no food for 2-3 hours before bedtime. 

[Sheryl]

P S. I neglected to mention, and not clear  if doctors told you  but bile duct stents canmot remain in long. Even if they don't clog/fail before then,  they have to be replaced after 3 months to avoid serious complications.

 

Much better to just get the stone out so that no stent needed. 

 

Both stent replacement and lithotropic stone removal entail similar procedure. But the latter, combined with gallbladder removal later on, are a definitive cure. Stents are just a stop gap measure. 

[NewGuy]

Outstanding, comprehensive advice, helpful and spirit lifting.

[NewGuy]

As you requested Sheryl, I called the four hospitals mentioned.

 

1. Bangkok Hospital (Bangkok Branch):023 103 000

    I was told by the operator that they do have the ERCP capacity and recommended Dr. Aron Siripon

 

2. MedPark: 020 233 333

    Their operator said they have the ERCP capacity and recommended Dr. Santi Kulpatcharapang as well as Dr. Panipa Piyachapturrwat. That last name due to my old ears is probaby mispelled.

 

3. Bumrungrad: 020 668 888

     Their operator said they’ve the equipment and recommends Dr. Yubstan Satpawat, Dr. Tarrat Mekarowkamor, and Dr. Tessatol Kerbbsiricharat.

     

4. Samitivej (Sukhumvit Branch): 020 222 222

     Their operator said equipment available, recommended Dr. Rewat Boonanuwat, Dr. Pathipat Deuboronponykase, and Dr. Suppawat Jiraphairont.

 

Everything very  professionally done. Bangkok Hospital’s computer system could bring up 18 years of data from Pattaya, I haven’t gone to Bumrungrad for 6 years and haven’t been to either of the remaining hospitals.

 

i hope this helps.

 

Thanks.

[Sheryl]

5 hours ago, NewGuy said:

As you requested Sheryl, I called the four hospitals mentioned.

 

1. Bangkok Hospital (Bangkok Branch):023 103 000

    I was told by the operator that they do have the ERCP capacity and recommended Dr. Aron Siripon

 

2. MedPark: 020 233 333

    Their operator said they have the ERCP capacity and recommended Dr. Santi Kulpatcharapang as well as Dr. Panipa Piyachapturrwat. That last name due to my old ears is probaby mispelled.

 

3. Bumrungrad: 020 668 888

     Their operator said they’ve the equipment and recommends Dr. Yubstan Satpawat, Dr. Tarrat Mekarowkamor, and Dr. Tessatol Kerbbsiricharat.

     

4. Samitivej (Sukhumvit Branch): 020 222 222

     Their operator said equipment available, recommended Dr. Rewat Boonanuwat, Dr. Pathipat Deuboronponykase, and Dr. Suppawat Jiraphairont.

 

Everything very  professionally done. Bangkok Hospital’s computer system could bring up 18 years of data from Pattaya, I haven’t gone to Bumrungrad for 6 years and haven’t been to either of the remaining hospitals.

 

i hope this helps.

 

Thanks.

Every place can do ERCP. Did you specify ERCP with lithotropy?

 

Both of thd doctors mentioned at Med Park have experience removing large stones with lithotropy.  and have published about it.  They are

 

https://www.medparkhospital.com/en-US/doctors/dr-panida-piyachaturawat

 

https://www.medparkhospital.com/en-US/doctors/dr-santi-kulpatcharapong

 

Assuming Med Park has the  equipment, you should be fine with  them.

[NewGuy]

 I used the “capacity to do ERCP with mechanical lithotripsy” phrase on each call, sometimes spelling it out.  I will try to get a consultation with a MedPark doctor next week and then start the insurance outpatient procedures. MedPark will tell me when I should have the procedure, I guess.

 

Thank you so much.

[Puccini]

I wish you all the best with your operation and that you can get it soon.

[NewGuy]

Here is my update. I went to Med Park and had a consultation with Dr. Panipa Piyachapturrwat. She was easy to speak with, open, her English was fine and her approach was to listen to me and answer fully and completely. She reviewed the documentation from my earlier procedure. Almost immediately I felt she was competent and what I needed. She agreed to my comment that laser was the way to go. 
 

They had to get a laser in. Two weeks later I arrived at 8 a.m. and was processed, drugged, operated on and woke up in my room about 2 pm. I was told that the operation was a complete success. The anesthesiologist had great English and came by twice a day. Boy, did I sleep heavily. Among the drugs used was Fentanyl, powerful stuff. By 2 p.m. the day after the operation I was discharged and felt fine except for light pain/irritation in my stomach.

 

There was one unexpected event - they did not have an arrangement with my insurer, Allianz Ayudiah, previously known as Bupa and then Aetna. I paid 230,000 on my SCB credit card on my first visit and the balance of the 380,000 total bill when I was leaving. I went to Allianz here in Pattaya two days later, signed some forms, gave them the hospital documentation they needed and was told, if all was well, they would deposit the refund into my bank (I had brought the bank book).

 

What a difference between my two procedures, 30 hrs versus almost 5 days, staff the second time really well trained, friendly and polite, and confidence building medical professionals. Glad to be rid of the stent too.

 

I also received recommendations for a Dr. Parit at Bangkok Hospital Bangkok branch. He only has consultation hours early on the weekend and I was happy with Dr. Panipa. 

 

 

[Sheryl]

Thanks for the update and glad all went well.