[Intraoperative cholangiography as a routine method? A prospective, controlled, randomized study].
A prospective, controlled, randomized trial was conducted in 275 patients with symptomatic gall stone disease, whose history, laboratory data or sonographical findings did not suggest common bile duct stones. Of these patients, 137 did not undergo intraoperative fluoroscopic cholangiography (IOC), but in the remaining 138 patients IOC was attempted. In 111 cases (80.4%) the biliary system was sufficiently visualized. In 3 patients (2.7%) calculi in the cystic or common bile duct were diagnosed, which would have been overlooked without IOC. IOC was false-positive in one case. One year after the operation the patients were asked to return for a follow-up examination. Three patients in the group without IOC had had symptomatic passage of a stone, and one had a common bile duct stone removed by endoscopic papillotomy. A retained stone was discussed as etiology for a pancreatitis in a fifth patient in this group. No patient sustained long-term sequelae from the retained common bile duct stones. None of the patients in the IOC group had evidence of cholangiolithiasis at follow-up. There was no difference between the study groups concerning the incidence of post-operative complications. The operations with IOC lasted significantly longer (92 +/- 31 min vs 77 +/- 28 min). According to our data and those published earlier, the additional financial and logistic expenditure associated with routine IOC is not justified. Patients with the preoperative suspicion of a common bile duct stone should have endoscopic bile duct clearance (ERCP and EPT) prior to cholecystectomy.
Nies
C
C
Klinik für Allgemeinchirurgie, Philipps-Universität Marburg.
Bauknecht
F
F
Groth
C
C
Clerici
T
T
Bartsch
D
D
Lange
J
J
Rothmund
M
M
D000328:Adult; D000368:Aged; D002758:Cholangiography / Q000191:economics; D017081:Cholecystectomy, Laparoscopic / Q000191:economics; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation / Q000191:economics; D012680:Sensitivity and Specificity