Deepika Akolekar1, S J Nixon, R W Parks. 1. Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK. deepikaakolekar@gmail.com
Abstract
BACKGROUND/AIMS: The aim of this study was to assess the practice of performing intraoperative cholangiography (IOC) during laparoscopic cholecystectomy in a busy teaching hospital. METHODS: Data were obtained from a surgical database for patients who underwent laparoscopic cholecystectomy between January 2000 and December 2003. The findings of IOC and follow-up were analysed. RESULTS: 1,651 patients were included in the study. Of the 745 patients (45.1%) who underwent IOC, this was normal in 586 patients and abnormal in 68 patients. Of these 68 patients, 4 underwent immediate conversion to open common bile duct exploration. 33 patients underwent endoscopic retrograde cholangiopancreatography and 31 patients were observed. During a median follow-up period of 920 days (range 371-1,821), 5 of the 745 patients had retained stones. Two patients re-presented after a failed IOC while 5 of the 906 patients from the non-cholangiogram group returned with stones. Of the 1,651 patients, definite stones were identified in 1.5% patients. CONCLUSION: When the surgeon deemed that IOC was not required, very few subsequent problems were encountered. An observational policy with monitoring of the liver function tests may be appropriate to avoid unnecessary invasive interventions in patients with an abnormal IOC. Copyright 2009 S. Karger AG, Basel.
BACKGROUND/AIMS: The aim of this study was to assess the practice of performing intraoperative cholangiography (IOC) during laparoscopic cholecystectomy in a busy teaching hospital. METHODS: Data were obtained from a surgical database for patients who underwent laparoscopic cholecystectomy between January 2000 and December 2003. The findings of IOC and follow-up were analysed. RESULTS: 1,651 patients were included in the study. Of the 745 patients (45.1%) who underwent IOC, this was normal in 586 patients and abnormal in 68 patients. Of these 68 patients, 4 underwent immediate conversion to open common bile duct exploration. 33 patients underwent endoscopic retrograde cholangiopancreatography and 31 patients were observed. During a median follow-up period of 920 days (range 371-1,821), 5 of the 745 patients had retained stones. Two patients re-presented after a failed IOC while 5 of the 906 patients from the non-cholangiogram group returned with stones. Of the 1,651 patients, definite stones were identified in 1.5% patients. CONCLUSION: When the surgeon deemed that IOC was not required, very few subsequent problems were encountered. An observational policy with monitoring of the liver function tests may be appropriate to avoid unnecessary invasive interventions in patients with an abnormal IOC. Copyright 2009 S. Karger AG, Basel.
Authors: Kristin M Sheffield; Yimei Han; Yong-Fang Kuo; Courtney M Townsend; James S Goodwin; Taylor S Riall Journal: J Am Coll Surg Date: 2012-02-25 Impact factor: 6.113