An analysis of perioperative cholangiography in one thousand laparoscopic cholecystectomies.
BACKGROUND
We undertook this retrospective study to ascertain the proper role of perioperative cholangiography in the management of 1002 patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis.


METHODS
Nine hundred forty-one patients were categorized as being at high or low risk for choledocholithiasis according to the presence or absence of jaundice, pancreatitis, elevated bilirubin, alkaline phosphatase, serum glutamic-oxaloacetic transaminase, or radiographic evidence of common bile duct stones (CBDSs).


RESULTS
Intraoperative cholangiography (IOCG) and preoperative endoscopic retrograde cholangiopancreatography (ERCP) were equivalent in the detection of CBDSs, and laparoscopic common bile duct exploration (CBDE) was successful in 12 of the 21 patients (57%) in whom it was attempted. The ducts of the other 52 patients with CBDSs were successfully cleared by preoperative or postoperative ERCP.


CONCLUSIONS
Laparoscopic IOCG is successful in detecting CBDS in high-risk patients and half of these ducts can be cleared laparoscopically. The incidence of CBDS in low-risk patients is 1.7%, a risk that does not warrant routine cholangiography. These data suggest ERCP should be reserved for those at-risk individuals in whom IOCG or laparoscopic duct clearance has been unsuccessful.
Fiore
N F
NF
Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
Ledniczky
G
G
Wiebke
E A
EA
Broadie
T A
TA
Pruitt
A L
AL
Goulet
R J
RJ
Grosfeld
J L
JL
Canal
D F
DF
D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D042882:Gallstones / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007565:Jaundice / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D016343:Monitoring, Intraoperative; D010195:Pancreatitis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase; D001663:Bilirubin