The Operative Cholangiogram:Its Interpretation, Accuracy and Value in Association with Cholecystectomy

McCormick, James; Bremner, D. N.; Thomson, J. Michael; Mcnair, T.J.; Philp, T.

doi:10.1097/00000658-197412000-00019

Cited by 27 publications

(5 citation statements)

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“…The technique failed in one patient in whom there was much oedema of the ductal system and there was one false positive result in the series, which otherwise demonstrated the value of the simple technique. Routine operative cholangiography demonstrated significant abnormalities in the main ductal system of 10.8 per cent of the nonjaundiced patients, a finding which is consistent with previous reports (Havard, 1970;McCormick et al, 1974;Faris et al, 1975) and substantiates the thesis that operative cholangiography with demonstration of the termination of the cystic duct, both hepatic ducts, the common hepatic and the common bile ducts in their entirety should be an essential part of any operation on the biliary tree. If routine cholangiography had not been employed in this series of 324 non-jaundiced patients, 35 patients would undoubtedly have returned with 'post-cholecystectomy' symptoms that would have required reoperation.…”

Section: Discussionsupporting

confidence: 89%

Cholecystectomy and a simple technique of operative cholangiography

Devlin

Sahay

Tiwari

et al. 1978

British Journal of Surgery

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A simple, easily reproducible technique of operative cholangiography is described. The technique has three advantages: (a) there is no need to divide or ligate the cystic duct; (b) it demonstrates the cystic duct anatomy clearly and is particularly useful in demonstrating stones in that duct thus eliminating the hazard of the retained stone in the cystic duct stump; (c) it is possible to eliminate the problem of false positives due to air bubbles. A consecutive series of 442 cholecystectomy patients is reviewed. The overall operative mortality was 1.6 per cent; no death could be attributed to operative cholangiography. Thirty-five of 324 patients (10.8 per cent) with gallstones and no history of jaundice were shown to have unexpected abnormalities in the common bile duct.

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Section: Discussionsupporting

confidence: 89%

Cholecystectomy and a simple technique of operative cholangiography

Devlin

Sahay

Tiwari

et al. 1978

British Journal of Surgery

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“…McCormick et al 18 (1974) got a positive duct exploration rate of 77.7%, lower results as compared to ours, the difference may be due to the smaller number of patients in their case. Faris et al 13 (1975) got a positive duct exploration rate of 71.5% in their series of 400 patients.…”

Section: Discussioncontrasting

confidence: 63%

Is There A Need Of Intraoperative Cholangiograms In Patients Of Cholelithiasis With And Without Clinical Indication Of Common Bile Duct Exploration While Performing Open Or Laparoscopic Cholecystectomy?

2012

IJS

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Background and Objectives: The study has been conducted with the aim to assess the need of intraoperative cholangiogram in patients of cholelithiasis with and without the clinical indication of common bile duct exploration.Design and Setting: Prospective study in patients of cholelithiasis with and without the clinical indication of common bile duct exploration admitted in the surgical wards. Patients and Methods : The study included 485 consecutive patients of cholelithiasis with and without the clinical indication of common bile duct exploration over a period of five years. All these patients were subjected to detailed history and clinical examination and investigations. An intraoperative cholangiogram was performed in all studied patients. Every alternate case was subjected to laparoscopic and open cholecystectomy with or without common bile duct exploration. Data collected was tabulated and the pvalue measured.Results: In patients with indication of common bile duct exploration, intraoperative cholangiography could spare 60 out of 140 (42.86%) patients from unnecessary CBD exploration while in patients without indication of common bile duct exploration intraoperative cholangiography could pick stones in the common bile duct in 15 out of 345 (4.34%) patients only, with very significant p-value (p<0.005).Conclusion: Intraoperative cholangiography is applicable in selective cases only where the indications for its use exist to solve the dilemma of an operating surgeon in the form of preoperative status, abnormal biliary tract anatomy or a difficult cholecystectomy due to dense adhesions to get a clear road-map of the ductal system and also to minimize the rate of unnecessary pre-and post-operative endoscopic retrograde cholangio-pancreatography.

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“…Among t14,005 laparoscopic surgery cases analyzed in the United States, 561 major bile duct injuries (0.50%) and 401 bile leaks from the cystic duct or liver bed (0.38%) were reported [1]. The incidence of significant anomalies of the extrahepatic bile ducts and cystic duct has been reported to be 1.7% to 28% [11][12][13][14][15][16]. Moreover, in patients with acute suppuration or recurrent bouts of inflammation, the anatomic details may be obscured, making it difficult to avoid surgical injury [13].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic management of bile duct and bowel injury during laparoscopic cholecystectomy

2001

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Accidental injuries to the bile duct and bowel are significant risks of laparoscopic surgery and sometimes require conversion to open surgery. Although some of the injuries related to laparoscopic cholecystectomy can be managed by endoscopic techniques, laparoscopic surgery is not yet sufficiently perfected. We investigated the efficacy of laparoscopic management combined with endoscopic tube or stent insertion in cases of bile duct and bowel injuries during laparoscopic cholecystectomy. Laparoscopic cholecystectomy was attempted on 1,190 consecutive patients between April 1992 and June 1999. The first 70 patients underwent only preoperative intravenous infusion cholangiography (IVC), and the remaining 1,120 patients were subjected to both preoperative IVC and intraoperative cholangiography. We experienced 16 cases of bile duct injury (1.4%). Five patients with circumferential injuries of the bile duct were converted to open surgery for biliary reconstruction. The other 11 patients with partial laceration injuries of the bile duct and biliary leakage from the cystic duct underwent a laparoscopic simple closure technique. In 10 of these patients, an endoscopic tube or stent was inserted on the day after surgery to facilitate biliary decompression and drainage. Bowel injuries occurred in seven patients (0.6%). Three intestinal injuries were due to careless technique, and two duodenal injuries and two intestinal injuries were related to dense adhesions. All of these injuries were successfully repaired using laparoscopic techniques, autosuturing devices, or extracorporeal suturing via the umbilical incision. No postoperative complications were identified. We concluded that the biliary injury site could be closed with a laparoscopic technique so long as the biliary injury was not circumferential. Bowel injuries also could be repaired laparoscopically.

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The Operative Cholangiogram:Its Interpretation, Accuracy and Value in Association with Cholecystectomy

Cited by 27 publications

References 0 publications

Cholecystectomy and a simple technique of operative cholangiography

Cholecystectomy and a simple technique of operative cholangiography

Is There A Need Of Intraoperative Cholangiograms In Patients Of Cholelithiasis With And Without Clinical Indication Of Common Bile Duct Exploration While Performing Open Or Laparoscopic Cholecystectomy?

Laparoscopic management of bile duct and bowel injury during laparoscopic cholecystectomy

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