Abstract
Background: The aim of this study was to retrospectively assess the usefulness of the preoperative oral cholecystogram (OCG) as an index to the feasibility of laparoscopic cholecystectomy (LC) and the operative pathologic findings. Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder (GB) disease. However, no definite diagnostic modality that can predict the feasibility of LC and severity of pathologic anatomy has been proposed.
Methods: Retrospective data were collected on 240 consecutive patients undergoing LC at St. Vincent Hospital, Catholic University Medical College, from October 1991 until December 1993. Radiologic interpretations of OCG were standardized according to the method of Koehler and Kyaw—from grade 0 to 4. And the operative findings—pericholecystic adhesion, color of GB, and thickness of the GB wall—were evaluated simultaneously.
Results: The analysis showed that preoperative OCG can predict intraoperative GB perforation (p = 0.022), intraoperative controllable bleeding (p = 0.034), and operating time (p = 0.0001) according to the grade of visualization of GB. Grade 2- or -better visualized groups had more patients who had blue-colored GB (p = 0.000) and who had thin GB wall (p =0.000).
Conclusions: Preoperative oral cholecystogram may be an accurate index of the feasibility of laparoscopic cholecystectomy—represented by operating time and important intraoperative minor complications related to the operative pathologic findings.
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References
Amberg JR, Juhl JH (1987) Imaging techniques—the gallbladder and biliary duct. In: Juhl JH, Crummy AB (eds) Paul and Juhl's essentials of radiologic imaging, 5th ed. Lippincott, Philadelphia, pp 492–496
Bailey RW, Imbembo AL, Zucker KA (1991) Establishment of a laparoscopic cholecystectomy training program. Am Surg 57: 231–236
Barkun JS, Barkun AN, Sampalis JS, Fried G, Taylor B, Wexler MJ, Goresky CA, Meakins JL (1992) Randomized controlled trial of laparoscopic versus minicholecystectomy. Lancet 2: 1116–1119
Berk RN, Lasser EC (1964) Altered concepts of the mechanism of nonvisualization of the gallbladder. Radiology 82: 296–302
Berk RN, Loeb PM (1983) Concentration in the gallbladder—biliary contrast materials. In: Berk RN, Ferrucci JT, Leopold GR (eds) Radiology of the gallbladder and bile ducts. WB Saunders, Philadelphia, p 69
Brink JA, Simeone JF, Mueller PR, Saini S, Tung GA, Spell NO, Ferrucci JT (1989) Routine sonographic techniques fail to quantify gallstone size and number: a retrospective study of 111 surgically proved cases. Am J Roentgenol 153: 503–506
Brodishi RJ, Fink AS (1993) ERCP, cholangiography, and laparoscopic cholecystectomy. The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) opinion survey. Surg Endosc 7: 3–8
Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161: 385–387
Dolgin SM, Schwartz S, Kressel HY, Soloway RD, Miller WT, Trotman BW, Soloway AS, Good LI (1981) Identification of patients with cholesterol or pigment gallstones by discriminant analysis of radiographic features. N Engl J Med 304: 808–811
Flowers JL, Bailey RW, Scovill WA, Zucker KA (1991) The Baltimore experience with laparoscopic management of acute cholecystitis. Am J Surg 161: 388–392
Frazee RC, Roberts JW, Symmonds R, Snyder SK, Hendricks J, Smith R, Custer MD (1992) What are the contraindications for laparoscopic cholecystectomy? Am J Surg 164: 491–494
Gai H, Thiele H (1992) Ultrasound selection criteria for laparoscopic cholecystectomy. Chirurg 63: 426–431
Gelfand DW, Wofman NT, Ott DJ, Watson NE, Chen YM, Dale WJ (1988) Oral cholecystography vs gallbladder sonography: a prospective blinded reappraisal. Am J Roentgenol 151: 69–72
Graham EA, Cole WH, Copher GH (1924) Visualization of the gallbladder by the sodium salt of tetrabromphenolphthalein. JAMA 82: 1777–1778
Graves HA, Ballinger JF, Anderson WJ (1991) Appraisal of laparoscopic cholecystectomy. Ann Surg 213: 655–661
Koehler PR, Kyaw MM (1973) Effect of fractionated administration of telepaque on gallbladder visualization. Radiology 108: 517–519
Lee C-L, Wu C-H, Chen T-K, Lai Y-C, Yang S-S, Huang C-S, Chen D-F (1993) Prospective study of abdominal ultrasonography before laparoscopic cholecystectomy. J Clin Gastroenterol 16: 113–116
Neuhaus H, Feussner H, Ungeheuer A, Hoffmann W, Siewert JR, Classen M (1992) Prospective evaluation of the use of endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy. Endoscopy 24: 745–749
Soper NJ, Dunegan DL (1992) Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy. World J Surg 16: 1133–1140
The Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324: 1073–1078
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Kim, J.G., Suh, Y.J., Moon, I.S. et al. Clinical implication of preoperative oral cholecystogram for laparoscopic cholecystectomy. Surg Endosc 10, 137–142 (1996). https://doi.org/10.1007/BF00188359
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DOI: https://doi.org/10.1007/BF00188359