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Imaging of the common bile duct in patients undergoing laparoscopic cholecystectomy

Lookup NU author(s): Paul Hainsworth, Professor Thomas Lennard

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Abstract

Options for managing the common bile duct during laparoscopic cholecystectomy include routine peroperative cholangiography and selected preoperative endoscopic retrograde cholangiopancreatography (ERCP). The use of these methods was reviewed in 350 patients with symptomatic gall stones referred for laparoscopic cholecystectomy. Unit A (n=114) performed routine cystic duct cholangiography but undertook preoperative ERCP in patients at very high risk of duct stones only; unit B (n=236) performed selected preoperative ERCP on the basis of known risk factors for duct stones. The detection rate for common bile duct stones was similar for units A and B (16% v 20%). In unit A, five of seven patients who had preoperative ERCP had duct stones. Operative cholangiography was technically successful in 90% of patients and duct stones were confidently identified in 13, one of whom went on to immediate open duct exploration. Postoperative ERCP identified duct stones in only four patients, indicating spontaneous passage in eight. In unit B, preoperative ERCP was undertaken in 76 of 236 (32%) patients and duct stones were identified in 47 (20%). Duct clearance was successful in 42 (18%) but failed in five (2%), necessitating elective open duct exploration. Both protocols for imaging the common bile duct worked well and yielded satisfactory short term results.


Publication metadata

Author(s): Hainsworth PJ, Rhodes M, Gompertz RHK, Armstrong CP, Lennard TWJ

Publication type: Article

Publication status: Published

Journal: Gut

Year: 1994

Volume: 35

Issue: 7

Pages: 991-995

Print publication date: 01/07/1994

ISSN (print): 0017-5749

ISSN (electronic): 1468-3288

URL: http://dx.doi.org/10.1136/gut.35.7.991

DOI: 10.1136/gut.35.7.991


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