Document Detail


Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy.
MedLine Citation:
PMID:  16738972     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is a matter of debate. METHODS: Data from 2,130 consecutive LCs and patients' follow-up during 9 years were collected and analyzed. During the first 4 years of the study, 800 patients underwent LC, and IOC was performed selectively (SIOC). Thereafter, 1,330 patients underwent LC, and IOC was routinely attempted (RIOC) for all. RESULTS: In the IOC group, 159 patients met the criteria for SIOC, which was completed successfully in 141 cases (success rate, 88.6%). Bile duct calculi were found in nine patients. All other patients with no criteria or failed SIOC were followed, and in nine patients retained stones were documented. Thus, the incidence of ductal stones was 1.1% and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for the detection of ductal stones were 50, 100, 98.6, and 100%, respectively. In the RIOC group, IOC was routinely attempted in 1,330 patients and was successful in 1,133 (success rate, 90.9%; p = 0.015). Bile duct stones were detected in 37 patients (including 14 asymptomatic stones). In two cases, IOC failed to reveal ductal stones (false negative). There was no false-positive IOC. Therefore, with RIOC policy, the incidence of ductal stones, sensitivity, specificity, NPV, and PPV were 3.3, 97.4, 100, 99.8, and 100%, respectively (significantly higher for success rate, incidence, sensitivity, and NPV; p < 0.05). Abnormal IOC findings were also significantly higher in the RIOC group. Common bile duct injury occurred only in the SIOC group [two cases of all 2,130 LCs (0.09%)]. CONCLUSION: RIOC during LC is a safe, accurate, quick, and cost-effective method for the detection of bile duct anatomy and stones. A highly disciplined performance of RIOC can minimize potentially debilitating and hazardous complications of bile duct injury.
Authors:
A Nickkholgh; S Soltaniyekta; H Kalbasi
Publication Detail:
Type:  Case Reports; Comparative Study; Journal Article     Date:  2006-05-12
Journal Detail:
Title:  Surgical endoscopy     Volume:  20     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-06-01     Completed Date:  2006-09-21     Revised Date:  2007-01-26    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  868-74     Citation Subset:  IM    
Affiliation:
Department of General and Laparoscopic Surgery, Arad General Hospital, Tehran, Iran. arash_nickkholgh@med.uni-heidelberg.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Child
Cholangiography*
Cholecystectomy, Laparoscopic*
Common Bile Duct / injuries
Female
Follow-Up Studies
Gallstones / radiography
Humans
Intraoperative Care*
Intraoperative Complications / prevention & control
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Wounds and Injuries / prevention & control
Comments/Corrections
Comment In:
Nat Clin Pract Gastroenterol Hepatol. 2007 Jan;4(1):16-7   [PMID:  17203082 ]

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