Abstract
The introduction of laparoscopic cholecystectomy, improvements in ultrasound technology and the success of endoscopic sphincterotomy have raised new questions regarding the role of intraoperative cholangiography. Our aim was to analyse the ability of preoperative clinical and ultrasound assessments to detect common duct stones in 86 patients with symptomatic cholecystolithiasis who then underwent cholangiography after percutaneous cholecystolithotomy. Six patients gave a history suggestive of common duct stones (either jaundice, cholangitis or pancreatitis). Ultrasound showed a dilated common duct in four patients (normal < 6 mm), and one of these had a stone demonstrated in the duct. The latter patient and one other with a dilated common duct had stones on cholangiography (which were extracted at ERCP), no stones were demonstrated in the other two. Ultrasound correctly identified common duct stones in two and excluded common duct stones in four others with a history suggesting the presence of stones. For patients undergoing laparoscopic cholecystectomy we would advocate the use of preoperative ultrasound instead of intraoperative cholangiography, and that endoscopic retrograde cholangiopancreatography is performed in the small number of patients shown to have a dilated duct or common duct stone.
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- Andrén-Sandberg A., Alinder G., Bengmark S. Accidental lesions of the common bile duct at cholecystectomy. Pre- and perioperative factors of importance. Ann Surg. 1985 Mar;201(3):328–332. [PMC free article] [PubMed] [Google Scholar]
- Cooperberg P. L., Li D., Wong P., Cohen M. M., Burhenne H. J. Accuracy of common hapatic duct size in the evaluation of extrahepatic biliary obstruction. Radiology. 1980 Apr;135(1):141–144. doi: 10.1148/radiology.135.1.7360952. [DOI] [PubMed] [Google Scholar]
- Doyle P. J., Ward-McQuaid J. N., Smith A. M. The value of routine peroperative cholangiography--a report of 4000 cholecystectomies. Br J Surg. 1982 Oct;69(10):617–619. doi: 10.1002/bjs.1800691020. [DOI] [PubMed] [Google Scholar]
- Dubois F., Icard P., Berthelot G., Levard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg. 1990 Jan;211(1):60–62. doi: 10.1097/00000658-199001000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Heinerman P. M., Boeckl O., Pimpl W. Selective ERCP and preoperative stone removal in bile duct surgery. Ann Surg. 1989 Mar;209(3):267–272. doi: 10.1097/00000658-198903000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hunt D. R., Reiter L., Scott A. J. Pre-operative ultrasound measurement of bile duct diameter: basis for selective cholangiography. Aust N Z J Surg. 1990 Mar;60(3):189–192. [PubMed] [Google Scholar]
- Jacobs J. K., Cebul R. D., Adamson T. E. Acute cholecystitis. Evaluation of factors influencing common duct exploration. Am Surg. 1986 Apr;52(4):177–181. [PubMed] [Google Scholar]
- Karusseit V. O., Mieny C. J. Is routine intra-operative cholangiography warranted? S Afr J Surg. 1987 Jun;25(2):54–55. [PubMed] [Google Scholar]
- Mansberger J. A., Davis J. B., Scarborough C., Bowden T. A. Selective intraoperative cholangiography. A case for its use on an anatomic basis. Am Surg. 1988 Jan;54(1):31–33. [PubMed] [Google Scholar]
- Neoptolemos J. P., Rowley S. Advantages of nonsurgical treatment of bile duct stones. Hepatogastroenterology. 1989 Oct;36(5):313–316. [PubMed] [Google Scholar]
- Pernthaler H., Sandbichler P., Schmid T., Margreiter R. Operative cholangiography in elective cholecystectomy. Br J Surg. 1990 Apr;77(4):399–400. doi: 10.1002/bjs.1800770414. [DOI] [PubMed] [Google Scholar]
- Stott M. A., Farrands P. A., Guyer P. B., Dewbury K. C., Browning J. J., Sutton R. Ultrasound of the common bile duct in patients undergoing cholecystectomy. J Clin Ultrasound. 1991 Feb;19(2):73–76. doi: 10.1002/jcu.1870190203. [DOI] [PubMed] [Google Scholar]
- Van Stiegmann G., Pearlman N. W., Goff J. S., Sun J. H., Norton L. W. Endoscopic cholangiography and stone removal prior to cholecystectomy. A more cost-effective approach than operative duct exploration? Arch Surg. 1989 Jul;124(7):787–790. doi: 10.1001/archsurg.1989.01410070037008. [DOI] [PubMed] [Google Scholar]