Intravenous cholangiography and the management of choledocholithiasis prior to laparoscopic cholecystectomy.
The preoperative diagnosis of choledocholithiasis simplifies the laparoscopic management of biliary tract disease. Slow infusion intravenous cholangiography (SI-IVC) may be an accurate and cost-effective screening test for choledocholithiasis, and it is safer than traditional intravenous cholangiography. Forty-nine patients underwent SI-IVCs for suspected choledocholithiasis. These patients subsequently had endoscopic retrograde cholangiograms (ERC) or intraoperative cholangiograms (IOC) during laparoscopic cholecystectomies. Sixteen SI-IVCs demonstrated choledocholithiasis; 13 were confirmed by ERCs or by IOCs. The remaining 33 patients with negative SI-IVCs had negative ERCs or IOCs. The sensitivity, specificity, and accuracy of detecting choledocholithiasis by SI-IVC were 100%, 92%, and 94%. Only one patient had a mild reaction to the contrast agent. In our hospital the cost of an SI-IVC is $324, the cost of an IOC is $393 (including operating room and anesthesia costs), and the cost of an ERC is $1,085. SI-IVC is an accurate method of preoperative screening for choledocholithiasis. It is safe and cost-effective.
Dorenbusch
M J
MJ
Surgery Education Program, Methodist Hospital of Indiana, Inc., Indianapolis, USA.
Maglinte
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Graffis
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000191:economics; D002648:Child; D002758:Cholangiography / Q000191:economics; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics; D017081:Cholecystectomy, Laparoscopic; D003362:Cost-Benefit Analysis; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007262:Infusions, Intravenous; D007458:Iodipamide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics; D015641:Radiography, Interventional / Q000191:economics; D012680:Sensitivity and Specificity
D007458:Iodipamide; C006753:meglumine iodipamide