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Consequences of routine peroperative cholangiography during cholecystectomy for gallstone disease: A prospective, randomized study

Abstract

To assess the value of routine peroperative cholangiography (PC), 457 patients undergoing cholecystectomy for gallstone disease were prospectively screened for the presence of 11 predefined criteria indicating possible choledocholithiasis. Two hundred and eighty patients who had no positive criteria and in whom preoperative endoscopic retrograde cholangiography (ERC) had not been performed were randomized to PC or no PC. The patients were followed up 12 months postoperatively, and those who had signs or symptoms of possible retained common bile duct calculi were referred to ERC. The difference in mean operative time between the 2 treatment groups was 23.3 minutes. Four patients (2.8%) in the PC group had unsuspected common bile duct calculi, and in 3 patients (2.1%), the PC was false-positive. On follow-up, no case of retained common bile duct calculi was found in either group. The rate of postoperative complications was significantly higher in the PC group than in the non-PC group. It is concluded that PC should be performed only in patients with indications of common bile duct disease or in whom clarification of the anatomy is necessary.

Résumé

Pour apprécier la valeur de la cholangiographie opératoire de routine, 457 sujets subissant une cholécystectomie pour lithiase vésiculaire ont été étudiés prospectivement en fonction de 11 critères de présomption de lithiase cholédocienne. Deux cent quatre-vingts d'entre eux qui ne présentaient pas un critère de présomption et chez qui n'avait pas été pratiquée une cholangiographie rétrograde endoscopique ont été soumis à une cholangiographie opératoire à la suite d'un choix par tirage au sort. Ils furent ensuite suivis pendant une période de 12 mois au décours de l'intervention de manière que ceux qui présentaient des symptômes et des signes en faveur de la présence de calculs oubliés dans le cholédoque fussent soumis à une cholangiographie rétrograde endoscopique. Premier élément, la durée de l'intervention fut augmentée en moyenne de 23.3 minutes lorsque fut pratiquée la cholangiographie opératoire. Quatre malades (2.8%) ainsi explorés présentaient des calculs cholédociens. Trois cas de faux positifs (2.1%) furent enregistrés. Aucun cas de lithiase résiduelle n'a été découvert dans les 2 groupes. Le taux des complications postopératoires fut plus élevée lorsque la cholangiographie opératoire fut pratiquée. On peut conclure de ces faits, que cette exploration doit Être proposée seulement lorsque la présence de calculs dans la voie biliare principale est à envisager ou quand il est nécessaire de préciser l'anastomie des voies biliares.

Resumen

Con el objeto de determinar el valor de la colangiografía peroperatoria (CP), 457 pacientes programados para colecistectomía por enfermedad litiásica biliar fueron preoperatoriamente tamizados para establecer la presencia de 11 criterios predefinidos indicando posible coledocolitiasis. Doscientos ochenta pacientes que no presentaban criterios positivos y en quienes la colangiografía retrógrada endoscópica (CRE) no había sido practicada fueron asignados al azar a CP o a no CP. Los pacientes fueron seguidos por 12 meses después de la operación, y aquellos con signos o síntomas de posibles cálculos retenidos en el colédoco fueron referidos para CRE. La diferencia en el tiempo operatorio promedio entre los 2 grupos fue de 23.3 minutos. Cuatro pacientes (2.8%) en el grupo con CP presentaron cálculos inesperados en el colédoco, y en 3 casos (2.1%), la CP resultó falsapositiva. En el curso del seguimiento, ningÚn caso de cálculos retenidos en el colédoco fue hallado en uno u otro grupo. La tasa de complicaciones postoperatorias fue significativamente mayor en el grupo con CP que en el grupo sin CP. Se concluye que la CP debe ser practicada sólo en pacientes con criterios de patología coledociana o en quienes sea necesario clarificar la anatomía.

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Correspondence to Martin Hauer-Jensen M.D..

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Hauer-Jensen, M., Kåresen, R., Nygaard, K. et al. Consequences of routine peroperative cholangiography during cholecystectomy for gallstone disease: A prospective, randomized study. World J. Surg. 10, 996–1001 (1986). https://doi.org/10.1007/BF01658656

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Keywords

  • Common Bile Duct
  • Retained
  • Choledocholithiasis
  • Gallstone Disease
  • Mese