The value of routine peroperative cholangiography—a report of 4000 cholecystectomies

Abstract

A total of 4000 consecutive cholecystectomies performed over a period of 25 years has been analysed to determine whether routine peroperative cholangiography (PC) has influenced overall mortality. The patients have been divided into four cohorts of 1000, the first cohort before the introduction of PC, two covering the period of introduction of PC and the final cohort when PC was an established routine. A significant fall in overall mortality has been demonstrated, but when the patients are divided into simple cholecystectomy and the group undergoing additional choledochotomy there is no significant fall in the mortality rate. The mortality rate for the latter group is three or four times greater than that for the cholecystectomy alone group. The main contribution to the lower mortality is the reduced duct exploration rate following the introduction of PC. The stone recovery rate has improved from 34 to 71 per cent. The use of routine PC during cholecystectomy is recommended.

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].…”

Gallstone Disease Masking Malignant Bile Duct Tumors: A Rare but Important Coincidence

“…Debate, however, continues over the value of intraoperative cholangiography since its introduction by Mirizzi [9] in 1993. In the UK, the use of routine intraoperative cholangiography was recommended in 1982 [10]. In a study in 1988 by Cahill and Pain [11], 88% of the consultant general surgeons in the UK routinely performed this investigation during open cholecystectomy.…”

Operative Interdisziplinarit�t?Abdomen (ohne Becken)

“…Die endoskopische Entfernung von Gallengangssteinen hat im Vergleich zum konventionellen Vorgehen zu einer Senkung der Letalität bei älteren Patienten von bis zu 7,4 auf 0,2 bis 2,3% geführt [8],Mit Einführung der laparoskopischen Cholezystektomie hat die endoskopische Entfernung von Gallengangssteinen als er-…”