INTRAOPERATIVE CHOLANGIOGRAPHY AS A ROUTINE METHOD - A PROSPECTIVE, CONTROLLED, RANDOMIZED STUDY

A prospective, controlled, randomized trial was conducted in 275 patie nts with symptomatic gall stone disease, whose history, laboratory dat a or sonographical findings did not suggest common bile duct stones. O f these patients, 137 did not undergo intraoperative fluoroscopic chol angiography (IOC), but in the remaining 138 patients IOC was attempted . In 111 cases (80.4%) the biliary system was sufficiently visualized. In 3 patients (2.7%) calculi in the cystic or common bile duct were d iagnosed, which would have been overlooked without IOC. IOC was false- positive in one case. One year after the operation the patients were a sked to return for a follow-up examination. Three patients in the grou p without IOC had had symptomatic passage of a stone, and one had a co mmon bile duct stone removed by endoscopic papillotomy. A retained sto ne was discussed as etiology for a pancreatitis in a fifth patient in this group. No patient sustained long-term sequelae from the retained common bile duct stones. None of the patients in the IOC group had evi dence of cholangiolithiasis at follow-up. There was no difference betw een the study groups concerning the incidence of post-operative compli cations. The operations with IOC lasted significantly longer (92 +/- 3 1 min vs 77 +/- 28 min). According to our data and those published ear lier, the additional financial and logistic expenditure associated wit h routine IOC is not justified. Patients with the preoperative suspici on of a common bile duct stone should have endoscopic bile duct cleara nce (ERCP and EPT) prior to cholecystectomy.