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‘Critical View of Safety’ as an Alternative to Routine Intraoperative Cholangiography During Laparoscopic Cholecystectomy for Acute Biliary Pathology

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

The study aims to evaluate the use of “critical view of safety” (CVS) for the prevention of bile duct injuries during laparoscopic cholecystectomy for acute biliary pathology as an alternative to routine intraoperative cholangiography (IOC).

Methods

A policy of routine CVS to identify biliary anatomy and selective IOC for patients suspected to have common bile duct (CBD) stone was adopted. Receiver operator curves (ROCs) were used to identify cutoff values predicting CBD stones.

Results

Four hundred forty-seven consecutive, same admission laparoscopic cholecystectomies performed between August 2004 and July 2007 were reviewed. CVS was achieved in 388 (87%) patients. Where CVS was not possible, the operation was completed open. CBD stones were identified in 22/57 patients who underwent selective IOC. Preoperative liver function and CBD diameter were significantly higher in those with CBD stones (P < .001). ROC curve analysis identified preoperative cutoff values of bilirubin (35 μmol/L), alkaline phosphatase (250 IU/L), alanine aminotransferase (240 IU/L), and a CBD diameter of 10 mm, as predictive of CBD stones. No bile duct injuries occurred in this series.

Conclusion

In acute biliary pathology, the use of CVS helps clarify the anatomy of Calot's triangle and is a suitable alternative to routine IOC. Selective cholangiography should be employed when preoperative liver function and CBD diameter are above defined thresholds.

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Authors and Affiliations

  1. Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland

    Pandanaboyana Sanjay, Jennifer L. Fulke & David J. Exon

Authors
  1. Pandanaboyana Sanjay
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  2. Jennifer L. Fulke
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  3. David J. Exon
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Correspondence to Pandanaboyana Sanjay.

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Sanjay, P., Fulke, J.L. & Exon, D.J. ‘Critical View of Safety’ as an Alternative to Routine Intraoperative Cholangiography During Laparoscopic Cholecystectomy for Acute Biliary Pathology. J Gastrointest Surg 14, 1280–1284 (2010). https://doi.org/10.1007/s11605-010-1251-6

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  • DOI: https://doi.org/10.1007/s11605-010-1251-6

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