Is operative cholangiography always necessary?

Abstract

To determine whether operative cholangiography could be performed on a selective basis, 272 consecutive patients undergoing cholecystectomy and routine operative cholangiography were studied prospectively. Appropriate clinical, biochemical and operative data were recorded and the surgeon was asked to estimate the likelihood of common bile duct stones. These factors were correlated with the subsequent cholangiographic and operative findings. From this information, four criteria were selected as indications for performing an operative cholangiogram: an abnormal common bile duct, a wide cystic duct, or elevated levels of alkaline phosphatase or bilirubin documented in the previous six months. Operative cholangiograms would have been indicated by the presence of one or more of these criteria in only 139 of the 272 patients in the study (51 per cent). Only one unsuspected stone would have been missed. It is concluded that a policy of selective cholangiography could have been safely adopted in this series of patients.

Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy

“…On the basis of the literature [13,19,44,45,50], gallstones were classified as dangerous or not dangerous: multiple gallstones were classified as dangerous when they were micro, small, or heterogeneous in size; multiple gallstones were considered not dangerous when they were medium-or large-sized; and a single stone, irrespective of dimension, was classified as not dangerous.…”

Factors Predictive of Bile Duct Stones in Patients with Acute Calculous Cholecystitis

“…It has been performed either routinely [1, 2, 3, 4] or selectively [5, 6, 7, 8, 9, 10, 11, 12, 13] to detect bile duct calculi or anomalies, to avoid unnecessary bile duct explorations and retained stones as well as peroperative duct injuries. Except for cholangiography, identification of patients with bile duct stones can be achieved by patients’ clinical features [10, 13, 14, 15, 16, 17, 18], liver function tests [10, 12, 15, 16, 17, 18, 19, 20] or peroperative findings [10, 13, 14, 16, 18, 19].…”

Predição da coledocolitíase pela associação de indicadores clínicos e laboratoriais em dois momentos do pré-operatório da colecistectomia

“…No HSPE-FMO, estudo anterior mostrou incidência de litíase na VBP de 15%, abaixo dos 27% constatados no presente estudo 16 . Os cálculos na VBP são mais freqüentes com o avançar da idade, constatando-se associação entre a incidência desta doença e idade superior a 60 anos 23,24 . A média de idade dos doentes com coledocolitíase costuma ser de 9 a 10 anos maior que a dos pacientes sem essa doença 21,25 .…”

“…Este fato já foi constatado, sendo a predisposição do sexo masculino à coledocolitíase atribuída ao maior diâmetro da VBP e à demora em procurar atendimento médico 11,16 . Embora a icterícia seja importante sintoma em pacientes com cálculos na VBP, os pacientes anictéricos também podem apresentar esta doença, levantando dúvidas a respeito do real papel desempenhado por este sintoma no que se refere ao diagnostico precoce da coledocolitíase 7,23,25,27,28 . Nos doentes anictéricos, os exames laboratoriais tornar-seiam ainda mais importantes, pois poderiam identificar anormalidades sugestivas da coledocolitíase 7,25,27,28 .…”