Background and Study Aims: A prerequisite for successful laparoscopic
cholecystectomy is the exclusion of potential risks such as cholangiol
ithiasis or anatomical malformations, As there is no general agreement
regarding the appropriate preoperative diagnostic work-up, a comparat
ive study of different diagnostic methods was tarried out. Patients an
d Methods: In 180 consecutive patients admitted to a community hospita
l for cholecystectomy due to symptomatic cholecystolithiasis, a prospe
ctive comparison was carried out of the diagnostic accuracy of patient
history, physical examination, laboratory tests, upper gastrointestin
al endoscopy, intravenous cholangiography, ultrasonography, and endosc
opic retrograde cholangiopancreatography (ERCP). Results: Measurement
of the diameter of the common bile duct was found to be a reliable met
hod as a single noninvasive parameter for diagnosing cholangiolithiasi
s (sensitivity 100%, specificity 93%), with good predictive power (pos
itive predictive value 0.7, negative predictive value 1.0). The best a
ccuracy achieved noninvasively and without sonography aas with a combi
nation of positive patient history and gamma-glutamyl transferase find
ings (sensitivity 58%, specificity 84%, positive predictive value 0.37
, negative predictive value 0.93). ERCP detected additional cholangiol
ithiasis in 19 of 139 patients (13.7%) and anatomical malformations in
three patients. In all 13 patients, the bile duets were cleared of st
ones endoscopically within 24 hours, prior to laparoscopic cholecystec
tomy. Among the 163 patients primarily assigned to laparoscopic cholec
ystectomy, the protocol diagnostic work-up, including ERCP, allocated
three patients (1.8%) to open surgery, Conversion from laparoscopic ch
olecystectomy to open cholecystectomy occurred in a further two of 158
patients (1.3 %). Conclusions: These results show that routine ultras
onography prior to laparoscopic cholecystectomy can lie recommended in
order to determine the diameter of the common bile duct, in patients
with a ductal diameter of more than 6 mm, ERCP should be performed, La
paroscopic cholecystectomy can be carried out within 24 hours after ER
CP and papillotomy.