title: Is ductal evaluation always necessary before or during surgery for biliary pancreatitis?
abstract: BACKGROUND
  Whether all patients undergoing cholecystectomy following an episode of biliary pancreatitis require direct common bile duct evaluation is controversial. We hypothesized such evaluation can be omitted safely among select patients at low risk for choledocholithiasis.
  
  
  METHODS
  One hundred forty-eight patients undergoing cholecystectomy for biliary pancreatitis (January 1995-December 2005) met the following inclusion criteria: (1) no preoperative endoscopic retrograde cholangiography (ERC) or endoscopic retrograde cholangiopancreatography (ERCP); (2) normal or decreasing liver function tests (LFTs) preoperatively; and (3) no ductal dilation on non-invasive preoperative imaging. Group I had intraoperative cholangiography (IOC, n = 27); group II did not (n = 121).
  
  
  RESULTS
  No differences between groups I and II were evident in postoperative retained-stone related events: recurrent pancreatitis (11% vs 8%, P = .7), cholangitis (0% in both groups), and asymptomatic LFT elevation (0% vs 3%, P > .99).
  
  
  CONCLUSIONS
  Direct ductal evaluation can be omitted safely in select patients undergoing cholecystectomy for biliary pancreatitis who are at low risk for choledocholithiasis.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Kaori
authors.initials: K
authors.lastname: Ito
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ito
authors.forename: Ali
authors.initials: A
authors.lastname: Tavakkolizadeh
authors.forename: Edward E
authors.initials: EE
authors.lastname: Whang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000473:pathology*; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D042883:Choledocholithiasis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000601:surgery*; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment