| Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy. | |
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MedLine Citation:
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PMID: 16738972 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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A Nickkholgh; S Soltaniyekta; H Kalbasi |
Publication Detail:
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Type: Case Reports; Comparative Study; Journal Article Date: 2006-05-12 |
Journal Detail:
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Title: Surgical endoscopy Volume: 20 ISSN: 1432-2218 ISO Abbreviation: Surg Endosc Publication Date: 2006 Jun |
Date Detail:
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Created Date: 2006-06-01 Completed Date: 2006-09-21 Revised Date: 2007-01-26 |
Medline Journal Info:
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Nlm Unique ID: 8806653 Medline TA: Surg Endosc Country: Germany |
Other Details:
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Languages: eng Pagination: 868-74 Citation Subset: IM |
Affiliation:
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Department of General and Laparoscopic Surgery, Arad General Hospital, Tehran, Iran. arash_nickkholgh@med.uni-heidelberg.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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Nat Clin Pract Gastroenterol Hepatol. 2007 Jan;4(1):16-7
[PMID:
17203082
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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