Operative cholangiography: Is there a statistical alternative?

Taylor, T. V.; Torrance, Bruce; Rimmer, S.; Hillier, V.; Lucas, S. B.

doi:10.1016/0002-9610(83)90112-5

Cited by 34 publications

(12 citation statements)

References 10 publications

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“…The attempts proposed in the literature to combine different indicators have resulted in complicated proceedings using multivariate analysis [3,19] or discriminant functions [46], implying the use of a computer program, which is not always available during the diagnostic workup. In recent years, some authors have maintained that the risk of migration of gallbladder stones to the biliary tree is higher the smaller and/or more numerous they are, rather than if the stones are single or large [13,19,44,45,50]. Taking into consideration the results of these studies, in our study gallstones were evaluated by ultrasound examination and were classified as dangerous or not dangerous on the basis of number and size.…”

Section: Discussionmentioning

confidence: 99%

“…On the basis of the literature [13,19,44,45,50], gallstones were classified as dangerous or not dangerous: multiple gallstones were classified as dangerous when they were micro, small, or heterogeneous in size; multiple gallstones were considered not dangerous when they were medium-or large-sized; and a single stone, irrespective of dimension, was classified as not dangerous.…”

Section: Methodsmentioning

confidence: 99%

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Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy

et al. 2003

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy

et al. 2003

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“…It has been performed either routinely [1, 2, 3, 4] or selectively [5, 6, 7, 8, 9, 10, 11, 12, 13] to detect bile duct calculi or anomalies, to avoid unnecessary bile duct explorations and retained stones as well as peroperative duct injuries. Except for cholangiography, identification of patients with bile duct stones can be achieved by patients’ clinical features [10, 13, 14, 15, 16, 17, 18], liver function tests [10, 12, 15, 16, 17, 18, 19, 20] or peroperative findings [10, 13, 14, 16, 18, 19].…”

Section: Introductionmentioning

confidence: 99%

Factors Predictive of Bile Duct Stones in Patients with Acute Calculous Cholecystitis

Hammarström¹,

Ranstam²

1998

Dig Surg

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The objective of the study was to investigate the accuracy of using preoperative data for the prediction of bile duct calculi in patients operated on for acute cholecystitis. 279 consecutive patients underwent cholecystectomy with peroperative cholangiography for acute calculous cholecystitis in the Department of Surgery, Lund University Hospital, between 1985 and 1991. The correlation between 13 preoperative clinical and laboratory variables, and the incidence of bile duct calculi was studied. Among the 13 variables tested, serum bilirubin concentration and serum γ-glutamyltransferase activity were independent factors of predictive significance. These two factors were used for constructing an additive prognostic index for the presence of bile duct stones. Thus, three groups of patients could be identified having a 3, 7–9 or 59% risk of harboring bile duct stones, corresponding to a sensitivity of 61% and a specificity of 93% in predicting the presence of bile duct stones in the ‘high-risk’ group. Logistic regression analysis permits accurate preoperative identification of bile duct stones in patients with acute calculous cholecystitis.

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“…This is not the case with temporary, T-tube, decompressions after which, with or without the additional help of OPC or choledochoscopy, the occurrence of early retained/"missed" stones keeps being reported (22-29, Table 6). Over the past decade, a number of reports have shown the poor efficiency of routine OPC [33][34][35][36] while some others 33'37'3s have come to emphasize that a dilated CBD represents the most significant indicator of the presence of stones.…”

Section: Long Term Resultsmentioning

confidence: 99%

Standard Surgical Approaches to Primary Choledocholithiasis — Definitive VersusTemporary Decompression

et al. 1992

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The occurrence of retained/recurrent calculi after primary CBDE followed by temporary T-tube decompression, have remained at rates varying from 5.4% to 20.9% over the last 10 years in spite of sophisticated pre and intraoperative imaging techniques. It is postulated that a functional obstruction, due to dysmotility of the SO, lies behind most stone-containing ducts. Thus it seems logical to us that a permanent "fenestration" should be the management of most such ducts.We prospectively followed-up, for one to 10 years, two groups of patients submitted to primary CBDE aiming to assess the short and long-term results of two different surgical approaches to duct lithiasis. In one (Group A) 162 CBDE's were performed, out of 680 CHE's (24%), with a "positivity" of 68% and in the other (Group B) 80 CBDE's, out of 438 CHE's (18%)', with a "positivity" of 70%. In Group A a T-tube decompression was used in 79(49%) and a definitive drainage in 83(51%) whereas in Group B the T-tube was employed in only 3(4%) and some form of permanent "fenestration" in 77(96%). There were no significant differences between the operative mortality rates, which were 2.5% in Group A (1 death post T-tube, 3 post CDJ) and 1.3% in Group B (1 death post CDD). The long-term results, though, were significantly worse among patients of Group A whose ducts were temporarily decompressed: 10/79 (12.7%) required further aggressive interventional therapy for retained/recurrent stones while only 3.8% (3/80) in Group A and 1.3% (1/76) in Group B required revisional surgery for bilio-digestive anastomotic complications with cholangitis.It is concluded that it is against the long-term efficiency of the approach utilized in Group B that the new laparoscopic techniques should be compared.

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Operative cholangiography: Is there a statistical alternative?

Cited by 34 publications

References 10 publications

Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy

Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy

Factors Predictive of Bile Duct Stones in Patients with Acute Calculous Cholecystitis

Standard Surgical Approaches to Primary Choledocholithiasis — Definitive VersusTemporary Decompression

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