Routine or selective peroperative cholangiography

Abstract

The routine use of peroperative (pre-exploration) cholangiography was prospectively studied in 433 consecutive patients undergoing elective cholecystectomy. Satisfactory peroperative cholangiography was achieved in 396 patients using a C-arm image intensifier with image retention facility. Clinical indications for exploration of the common bile duct were noted for each patient but the decision for choledochotomy was determined by the cholangiographic results. Two hundred and forty-nine (63 per cent) patients had no clinical indications for duct exploration and cholangiographic findings were all normal. Of the 147 patients with positive clinical criteria, 39 (9.8%) had abnormal cholangiograms and required exploration of the common bile duct. In three patients duct exploration was negative giving a false positive rate of 0.73 per cent. The use of the image intensifier allowed dynamic study during cholangiography and optimum evaluation of the duct system. The results support the view that peroperative cholangiography could be restricted to patients with clinical indications for exploration of the common bile duct.

Routine vs ``on demand'' postoperative ERCP for small bile duct calculi detected at intraoperative cholangiography

“…The two groups were comparable for age and sex distribution (Table 1). Follow-up was available on all patients for a median period of 18 months (range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] in group A and 33 months (range, 13-48) in group B. The median number of outpatient clinic visits was significantly greater in patients assigned to observation (group B) than in patients who learned routine ERCP (groups A) (5.5 vs 3, p ‫ס‬ 0.011).…”

“…Transcystic exploration is a suitable and attractive alternative, but it may not be feasible in some patients [7,20]. Furthermore, laparoscopic CBD exploration requires additional equipment and expertise, as well as adding to the operative time and cost [17].…”

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

“…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].…”

Bariatric Surgery in Saudi Arabia

“…Although our society is known to have a high incidence of gallstone formation [11,12], only five patients (13%) were found to have gallstones and hence have had their gallbladders removed concomitantly during the gastroplasty. Western series shows a high incidence of gallstone formation following gastric bypass or partitioning procedures [13][14][15].…”