Intraoperative and postoperative biliary endoscopy (choledochoscopy).
The majority of choledocholithiasis patients still require surgery. If the stones are removed, the patient is cured. With modern cholangiography, the anatomy and the location of the calculi can be immediately identified at the beginning of the operation. In 6% of cases, anomalies of surgical importance are detected. The general surgeon is not an endoscopist and therefore, choledochoscopy is used infrequently. The introduction of video techniques changed this pattern because the learning curve is shorter and the procedure is easier and faster to perform with a higher success rate. A permanent (objective) record of the findings and the visualization of the sphincter location and function is an added bonus. If a stone is missed and the T-tube is inserted in the proper fashion, the same video choledochoscope which is employed in the intraoperative phase can be used in the postoperative period. In our experience (108 cases) we had a success rate of 98%. It can be performed on an outpatient basis. The surgeon should be acquainted with intraoperative and postoperative biliary endoscopy to improve the final outcome of this common and important surgical procedure.
Berci
G
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Cedars Sinai Medical Center, Los Angeles.
D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D042882:Gallstones / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D011184:Postoperative Period; D014741:Video Recording