Validation of the Lacaine-Huguier predictive score for choledocholithiasis: prospective study of 380 patients.
The aim of this study was to validate the Lacaine-Huguier score for the prediction of asymptomatic choledocholithiasis.


METHODS
The study enrolled patients over age 18 with symptomatic chronic or acute calculous cholecystitis. Patients already known to have common bile duct stones (CBDS), as evidenced by symptomatic presentation with acute cholangitis or acute gallstone pancreatitis, were not included. We compared the group of patients with a score less than 3.5 versus those with a score greater or equal to 3.5; we also compared the group of patients who underwent intraoperative cholangiography (IOC) with those who did not undergo IOC. The negative predictive value of the Lacaine-Huguier score was calculated.


RESULTS
We note that 308 women and 72 men were consecutively enrolled between February 2008 to March 2009; the average age was 51±16.4 years. The score was less than 3.5 in 154 patients (40.5%). IOC was only performed in 135 of the 226 patients with a score greater or equal to 3.5; reasons for this included a very narrow cystic duct in 67 cases, preoperative miscalculation of the score in nine cases, a technical problem in eight cases, an unspecified reason in four cases, contraindication due to pregnancy in two cases, and intraoperative difficulties in one case. CBDS were detected by IOC in 18 cases. Performance of IOC lengthened the median operative time by 20 minutes. The median follow-up was 8 months (range: 0-30 months). Eleven patients were lost to follow-up (2.9%), six of these had a score less than 3.5. Two patients had residual common bile duct (CBD) stones, one of whom had a score less than 3.5. The negative predictive value was 99.4% (95% confidence interval (CI 95%)=[98-100%]). The risk of leaving a stone in the CBD was 0.6%. When data was analyzed according to the worst case scenario, the negative predictive value became 95.5% (CI 95%=[92-99%]) with a risk of residual CBDS of 4.5%.


CONCLUSIONS
This study confirmed the validity of the Lacaine-Huguier score. When the score is less than 3.5, the surgeon can refrain from performing IOC with a risk of asymptomatic residual CBDS ranging from 0.6% to 4.5%.
Service de chirurgie B, hôpital Charles-Nicolle, boulevard du 9-avril, 1006 Tunis, Tunisia.
M
M
Khalfallah
W
W
Dougaz
R
R
Bedoui
I
I
Bouasker
Y
Y
Chaker
R
R
Nouira
C
C
Dziri
D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D002758:Cholangiography; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000150:complications* / Q000601:surgery; D041761:Cholecystolithiasis / Q000150:complications* / Q000601:surgery; D042883:Choledocholithiasis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D002908:Chronic Disease; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies