G Singh1, P C Gupta, G Sridar, R N Katariya. 1. Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India. medinst@pgi.chd.nic.in
Abstract
BACKGROUND: The use of routine intra-operative cholangiography (IOC) remains controversial. This prospective study was carried out to determine whether to perform selective or routine IOC in patients undergoing cholecystectomy for gallstones. METHODS: All consecutive patients undergoing open cholecystectomy over a 16-month period were included in the present study. They were divided into two groups based on the absence (n = 79) or presence (n = 55) of indicators of choledocholithiasis. All patients were subjected to cholangiography. Each indicator, subsets of indicators and all indicators combined were evaluated for their ability to predict choledocholithiasis. RESULTS: There would be only two missed stones (1.5%) if selective cholangiography was to be practised. Intra-operative cholangiography had a positive predictive value of 100%. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of all the indicators combined were 93.5%, 84.6%, 74.5%, 97.5% and 88.0%, respectively. The best indicators in each subset were jaundice, common bile duct diameter as assessed by ultrasonography, and a palpable stone during surgery with NPV of 82.7%, 91.1% and 96.8%, respectively. CONCLUSION: Routine IOC during cholecystectomy is not essential for the prevention of retained stones. A combination of the various indicators of choledocholithiasis can be used to select patients for cholangiography.
BACKGROUND: The use of routine intra-operative cholangiography (IOC) remains controversial. This prospective study was carried out to determine whether to perform selective or routine IOC in patients undergoing cholecystectomy for gallstones. METHODS: All consecutive patients undergoing open cholecystectomy over a 16-month period were included in the present study. They were divided into two groups based on the absence (n = 79) or presence (n = 55) of indicators of choledocholithiasis. All patients were subjected to cholangiography. Each indicator, subsets of indicators and all indicators combined were evaluated for their ability to predict choledocholithiasis. RESULTS: There would be only two missed stones (1.5%) if selective cholangiography was to be practised. Intra-operative cholangiography had a positive predictive value of 100%. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of all the indicators combined were 93.5%, 84.6%, 74.5%, 97.5% and 88.0%, respectively. The best indicators in each subset were jaundice, common bile duct diameter as assessed by ultrasonography, and a palpable stone during surgery with NPV of 82.7%, 91.1% and 96.8%, respectively. CONCLUSION: Routine IOC during cholecystectomy is not essential for the prevention of retained stones. A combination of the various indicators of choledocholithiasis can be used to select patients for cholangiography.
Authors: William W Hope; Robert Fanelli; Danielle S Walsh; Vimal K Narula; Ray Price; Dimitrios Stefanidis; William S Richardson Journal: Surg Endosc Date: 2017-03-31 Impact factor: 4.584
Authors: Michael F Byrne; Mark T McLoughlin; Robert M Mitchell; Henning Gerke; K Kim; Theodore N Pappas; M S Branch; Paul S Jowell; John Baillie Journal: Surg Endosc Date: 2008-12-31 Impact factor: 4.584