Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1993 Sep;218(3):371–379. doi: 10.1097/00000658-199309000-00016

Cholecystectomy without operative cholangiography. Implications for common bile duct injury and retained common bile duct stones.

J S Barkun 1, G M Fried 1, A N Barkun 1, H H Sigman 1, E J Hinchey 1, J Garzon 1, M J Wexler 1, J L Meakins 1
PMCID: PMC1242982  PMID: 8373278

Abstract

OBJECTIVE: This study evaluated the selective use of endoscopic retrograde cholangiopancreatography (ERCP) in the context of laparoscopic cholecystectomy (LC) while minimizing the use of operative cholangiography. SUMMARY BACKGROUND DATA: There has been a long-standing debate between routine and selective operative cholangiography that has resurfaced with LC. METHODS: Prospective data were collected on the first 1300 patients undergoing LC at McGill University. Preoperative indications for ERCP were recorded, radiologic findings were standardized, and technical points for a safe LC were emphasized. RESULTS: A total of 106 patients underwent 127 preoperative ERCPs. Fifty patients were found to have choledocholithiasis (3.8%), and clearance of the common bile duct (CBD) with endoscopic sphincterotomy was achieved in 45 patients. The other five patients underwent open cholecystectomy with common duct exploration. Intraoperative cholangiography (IOC) was attempted in only 54 patients (4.2%), 6 of whom demonstrated choledocholithiasis. Forty-nine postoperative ERCPs were performed in 33 patients and stones were detected in 17 (1.3%), with a median follow-up time of 22 months. Endoscopic duct clearance was successful in all of these. The incidence of CBD injury was 0.38%, and a policy of routine operative cholangiography might only have led to earlier recognition of duct injury in one case. The rate of complication for all ERCPs was 9% and the associated median duration of the hospital stay was 4 days. The median duration of the hospital stay after open CBD exploration was 13 days. CONCLUSIONS: LC can be performed safely without routine IOC. The selective use of preoperative and postoperative ERCP will clear the CBD of stones in 92.5% of patients.

Full text

PDF
373

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barkun J. S., Barkun A. N., Sampalis J. S., Fried G., Taylor B., Wexler M. J., Goresky C. A., Meakins J. L. Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group. Lancet. 1992 Nov 7;340(8828):1116–1119. doi: 10.1016/0140-6736(92)93148-g. [DOI] [PubMed] [Google Scholar]
  2. Berci G., Sackier J. M., Paz-Partlow M. Routine or selected intraoperative cholangiography during laparoscopic cholecystectomy? Am J Surg. 1991 Mar;161(3):355–360. doi: 10.1016/0002-9610(91)90597-7. [DOI] [PubMed] [Google Scholar]
  3. Berci G., Sackier J. M. The Los Angeles experience with laparoscopic cholecystectomy. Am J Surg. 1991 Mar;161(3):382–384. doi: 10.1016/0002-9610(91)90602-a. [DOI] [PubMed] [Google Scholar]
  4. Corder A. P., Scott S. D., Johnson C. D. Place of routine operative cholangiography at cholecystectomy. Br J Surg. 1992 Sep;79(9):945–947. doi: 10.1002/bjs.1800790931. [DOI] [PubMed] [Google Scholar]
  5. Cotton P. B., Lehman G., Vennes J., Geenen J. E., Russell R. C., Meyers W. C., Liguory C., Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991 May-Jun;37(3):383–393. doi: 10.1016/s0016-5107(91)70740-2. [DOI] [PubMed] [Google Scholar]
  6. Flowers J. L., Zucker K. A., Graham S. M., Scovill W. A., Imbembo A. L., Bailey R. W. Laparoscopic cholangiography. Results and indications. Ann Surg. 1992 Mar;215(3):209–216. doi: 10.1097/00000658-199203000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hauer-Jensen M., Kåresen R., Nygaard K., Solheim K., Amlie E., Havig O., Viddal K. O. Predictive ability of choledocholithiasis indicators. A prospective evaluation. Ann Surg. 1985 Jul;202(1):64–68. doi: 10.1097/00000658-198507000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Johnson A. G., Hosking S. W. Appraisal of the management of bile duct stones. Br J Surg. 1987 Jul;74(7):555–560. doi: 10.1002/bjs.1800740703. [DOI] [PubMed] [Google Scholar]
  9. Kakos G. S., Tompkins R. K., Turnipseed W., Zollinger R. M. Operative cholangiography during routine cholecystectomy: a review of 3,012 cases. Arch Surg. 1972 Apr;104(4):484–488. doi: 10.1001/archsurg.1972.04180040098017. [DOI] [PubMed] [Google Scholar]
  10. Lillemoe K. D., Pitt H. A., Cameron J. L. Postoperative bile duct strictures. Surg Clin North Am. 1990 Dec;70(6):1355–1380. doi: 10.1016/s0039-6109(16)45289-8. [DOI] [PubMed] [Google Scholar]
  11. Litwin D. E., Girotti M. J., Poulin E. C., Mamazza J., Nagy A. G. Laparoscopic cholecystectomy: trans-Canada experience with 2201 cases. Can J Surg. 1992 Jun;35(3):291–296. [PubMed] [Google Scholar]
  12. Moossa A. R., Easter D. W., Van Sonnenberg E., Casola G., D'Agostino H. Laparoscopic injuries to the bile duct. A cause for concern. Ann Surg. 1992 Mar;215(3):203–208. doi: 10.1097/00000658-199203000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Moossa A. R., Mayer A. D., Stabile B. Iatrogenic injury to the bile duct. Who, how, where? Arch Surg. 1990 Aug;125(8):1028–1031. doi: 10.1001/archsurg.1990.01410200092014. [DOI] [PubMed] [Google Scholar]
  14. Neoptolemos J. P., Carr-Locke D. L., Fossard D. P. Prospective randomised study of preoperative endoscopic sphincterotomy versus surgery alone for common bile duct stones. Br Med J (Clin Res Ed) 1987 Feb 21;294(6570):470–474. doi: 10.1136/bmj.294.6570.470. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Neoptolemos J. P., Davidson B. R., Shaw D. E., Lloyd D., Carr-Locke D. L., Fossard D. P. Study of common bile duct exploration and endoscopic sphincterotomy in a consecutive series of 438 patients. Br J Surg. 1987 Oct;74(10):916–921. doi: 10.1002/bjs.1800741014. [DOI] [PubMed] [Google Scholar]
  16. Pace B. W., Cosgrove J., Breuer B., Margolis I. B. Intraoperative cholangiography revisited. Arch Surg. 1992 Apr;127(4):448–450. doi: 10.1001/archsurg.1992.01420040094016. [DOI] [PubMed] [Google Scholar]
  17. Pappas T. N., Slimane T. B., Brooks D. C. 100 consecutive common duct explorations without mortality. Ann Surg. 1990 Mar;211(3):260–262. [PMC free article] [PubMed] [Google Scholar]
  18. Phillips E. H., Carroll B. J., Pearlstein A. R., Daykhovsky L., Fallas M. J. Laparoscopic choledochoscopy and extraction of common bile duct stones. World J Surg. 1993 Jan-Feb;17(1):22–28. doi: 10.1007/BF01655700. [DOI] [PubMed] [Google Scholar]
  19. Sackier J. M., Berci G., Phillips E., Carroll B., Shapiro S., Paz-Partlow M. The role of cholangiography in laparoscopic cholecystectomy. Arch Surg. 1991 Aug;126(8):1021–1026. doi: 10.1001/archsurg.1991.01410320111016. [DOI] [PubMed] [Google Scholar]
  20. Schwab G., Pointner R., Wetscher G., Glaser K., Foltin E., Bodner E. Treatment of calculi of the common bile duct. Surg Gynecol Obstet. 1992 Aug;175(2):115–120. [PubMed] [Google Scholar]
  21. Sivak M. V., Jr Endoscopic management of bile duct stones. Am J Surg. 1989 Sep;158(3):228–240. doi: 10.1016/0002-9610(89)90256-0. [DOI] [PubMed] [Google Scholar]
  22. Soper N. J., Dunnegan D. L. Laparoscopic cholecystectomy: experience of a single surgeon. World J Surg. 1993 Jan-Feb;17(1):16–20. doi: 10.1007/BF01655698. [DOI] [PubMed] [Google Scholar]
  23. Soper N. J., Dunnegan D. L. Routine versus selective intra-operative cholangiography during laparoscopic cholecystectomy. World J Surg. 1992 Nov-Dec;16(6):1133–1140. doi: 10.1007/BF02067079. [DOI] [PubMed] [Google Scholar]
  24. Stain S. C., Cohen H., Tsuishoysha M., Donovan A. J. Choledocholithiasis. Endoscopic sphincterotomy or common bile duct exploration. Ann Surg. 1991 Jun;213(6):627–634. doi: 10.1097/00000658-199106000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Stiegmann G. V., Goff J. S., Mansour A., Pearlman N., Reveille R. M., Norton L. Precholecystectomy endoscopic cholangiography and stone removal is not superior to cholecystectomy, cholangiography, and common duct exploration. Am J Surg. 1992 Feb;163(2):227–230. doi: 10.1016/0002-9610(92)90106-2. [DOI] [PubMed] [Google Scholar]
  26. Williard W. C., Hajdu S. I., Casper E. S., Brennan M. F. Comparison of amputation with limb-sparing operations for adult soft tissue sarcoma of the extremity. Ann Surg. 1992 Mar;215(3):269–275. doi: 10.1097/00000658-199203000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES