The case against routine operative cholangiography

Gerber, Alex; Apt, Malcolm K.

doi:10.1016/0002-9610(82)90048-4

Cited by 70 publications

(13 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Routine operative cholangiography enabled us to detect stones in the bile ducts of 19 patients in this series (5.9%), which otherwise would have been overlooked and left behind. We feel that it is advantageous to locate and remove these silent common duct stones and that it is not appropriate to anticipate that these stones will pass spontaneously, as has been suggested [4].…”

Section: Discussionmentioning

confidence: 94%

Intraoperative endoscopy of the biliary tract

Thompson

Bennion

1988

Surg Endosc

View full text Add to dashboard Cite

This is a prospective series of 328 operations for biliary stone disease in 326 consecutive patients. The overall operative mortality was 0.6%. Routine operative cholangiography was utilized during cholecystectomy, and this identified 19 patients (5.9%) with silent common bile duct stones. Common bile duct explorations were positive in 62 of 74 operations (83.8%). Biliary endoscopy was routinely performed during bile duct exploration. Unsuspected retained common duct stones were discovered postoperatively in 4.5% of these patients. Biliary endoscopy proved essential in the management of 18 patients with radiographically demonstrated distal bile duct obstruction. With patency confirmed by endoscopy, inappropriate duodenotomy and sphincter ablation were avoided in each of these 18 patients.

show abstract

Section: Discussionmentioning

confidence: 94%

Intraoperative endoscopy of the biliary tract

Thompson

Bennion

1988

Surg Endosc

View full text Add to dashboard Cite

show abstract

“…There is also the risk of failure to clear such stones endoscopically at a later date. Some investigators have suggested ignoring all silent CBDS and not removing them [15,16], although it is generally considered that potentially serious complications from leaving stones in the duct should be avoided [30].…”

Section: Discussionmentioning

confidence: 99%

Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy

et al. 2003

View full text Add to dashboard Cite

show abstract

“…In 3% to 6% of the patients in whom CBD stones were detected, the stones were asymptomatic without preoperative indicators, negative abdominal ultrasound findings, or laboratory parameters [25,29,31]. It is believed that about 15% of these asymptomatic patients eventually will become symptomatic and require further interventional treatment [32].…”

Section: Endoscopic Sphincterotomy Versus Conservative Managementmentioning

confidence: 99%

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

et al. 2009

View full text Add to dashboard Cite

Background Recurrent attacks of acute biliary pancreatitis (RABP) are prevented by (laparoscopic) cholecystectomy. Since the introduction of endoscopic retrograde cholangiopancreaticography (ERCP), several series have described a similar reduction of RABP after endoscopic sphincterotomy (ES). This report discusses the different treatment options for preventing RABP including conservative treatment, cholecystectomy, ES, and combinations of these options as well as their respective timing. Methods A search in PubMed for observational studies and clinical (comparative) trials published in the English language was performed on the subject of recurrent acute biliary pancreatitis and other gallstone complications after an initial attack of acute pancreatitis. Result Cholecystectomy and ES both are superior to conservative treatment in reducing the incidence of RABP. Cholecystectomy provides additional protection for gallstone-related complications and mortality. Observational studies indicate that cholecystectomy combined with ES is the most effective treatment for reducing the incidence of RABP attacks.Conclusion From the literature data it can be concluded that ES is as effective in reducing RABP as cholecystectomy but inferior in reducing mortality and overall morbidity. The combination of ES and cholecystectomy seems superior to either of the treatment methods alone. A prospective randomized clinical trial comparing ES plus cholecystectomy with cholecystectomy alone is needed.Keywords Acute biliary pancreatitis Á Cholecystectomy Á Endoscopic sphincterotomy Á ERCP Á Recurrent Acute biliary or gallstone pancreatitis (ABP) is an inflammatory condition of the pancreas induced by gallstones [1]. The initial treatment of ABP can be either conservative or interventional. The coexistence of cholangitis is an accepted indication for the performance of endoscopic retrograde cholangiopancreaticography (ERCP). However, whether this procedure is performed for patients with ABP depends on local expertise and guidelines, as is the decision to perform an endoscopic sphincterotomy (ES) [2][3][4][5].After patients have recovered from their first attack of ABP, most guidelines advocate a cholecystectomy to prevent a recurrent attack or other gallstone-related disorders such as symptomatic choledocholithiasis, cholecystitis, gallstone ileus, jaundice, and cholangitis [2][3][4][5]. ''Recurrent'' symptomatic choledocholithiasis after an initial attack of ABP may be preexisting common bile duct (CBD) stones not detected at the time of the primo episode or stones that migrated from the gallbladder into the CBD after initial stone clearance. Choledocholithiasis also may have developed newly within the bile duct after cholecystectomy.

show abstract

The case against routine operative cholangiography

Cited by 70 publications

References 18 publications

Intraoperative endoscopy of the biliary tract

Intraoperative endoscopy of the biliary tract

Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

Contact Info

Product

Resources

About