title: Clinical efficacy and safety of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration.
abstract: BACKGROUND
  Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration, and identified the factors that positively predict the presence of common bile duct stones.
  
  
  METHODS
  From January 2008 to January 2011, 252 of 1013 patients undergoing laparoscopic cholecystectomy received selective trans-cystic intra-operative cholangiography and primary suture following three-port laparoscopic common bile duct exploration. Their clinical data were analyzed retrospectively.
  
  
  RESULTS
  All operations were successful and none was converted to open surgery. The intra-operative cholangiography time was (8.3 ± 2.5) minutes, and the operative duration was (105.4 ± 23.1) minutes. According to selective intra-operative cholangiography, the positive predictive values of current jaundice, small gallstones (< 0.5 cm) and dilated cystic duct (> 0.3 cm), dilated common bile duct (> 0.8 cm), history of jaundice or gallstone pancreatitis, abnormal liver function test, and preoperative demonstration of suspected common bile duct stones on imaging were 87%, 25%, 42%, 15%, 32%, and 75% for common bile duct stones, respectively. Patients with several factors suggestive of common bile duct stones yielded higher numbers of positive cholangiograms. Unexpected stones were found in 13 patients (5.2%) by intra-operative cholangiography. The post-operative hospital stay was (4.7 ± 2.2) days. Post-operative bile leakage occurred in two cases, and these patients recovered by simple drainage for 3 - 7 days without re-operation. Of the 761 patients who underwent laparoscopic cholecystectomy alone, 5 (0.7%) presented with a retained common bile duct stone requiring intervention. The median follow-up was 12 months, and only one patient who once suffered from bile leakage presented with obstructive jaundice due to bile duct stenosis 6 months postoperatively. The other patients recovered without any serious complications.
  
  
  CONCLUSIONS
  Selective intra-operative cholangiography yields acceptably high positive results. It is a safe, effective, and minimally invasive approach in patients with suspected choledocholithiasis and primary suture following three-port laparoscopic common bile duct exploration.
authors.affiliation: Department of Minimally Invasive Surgery, the First People's Hospital of Changzhou, Suzhou University, Changzhou, Jiangsu 213003, China. czyysdl@163.com
authors.forename: Dong-Lin
authors.initials: DL
authors.lastname: Sun
authors.forename: Feng
authors.initials: F
authors.lastname: Zhang
authors.forename: Xue-Min
authors.initials: XM
authors.lastname: Chen
authors.forename: Hong-Yuan
authors.initials: HY
authors.lastname: Jiang
authors.forename: Chun
authors.initials: C
authors.lastname: Yang
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Sun
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.forename: Yue
authors.initials: Y
authors.lastname: Yang
authors.forename: Hui-Hua
authors.initials: HH
authors.lastname: Cai
authors.forename: Cao-Ye
authors.initials: CY
authors.lastname: Wang
authors.forename: Xin-Quan
authors.initials: XQ
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D042883:Choledocholithiasis / Q000000981:diagnostic imaging* / Q000601:surgery; D003135:Common Bile Duct / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult