BILIARY DISTENSIBILITY DURING PEROPERATIVE CHOLANGIOGRAPHY AS COMPARED TO PREOPERATIVE ULTRASOUND - A 4-YEAR FOLLOW-UP-STUDY

Introduction: It is well recognized that corrected bile duct diameters , as measured by endoscopic retrograde cholangiography (ERC), are ofte n significantly greater than the corresponding ultrasound measurement, This can be attributed to variation in bile duct distensibility and i s particularly noted in post cholecystectomy patients, possibly due to loss of the gall bladder reservoir effect. It has been suggested that increased bile duct distensibility may be related to the post-cholecy stectomy syndrome. We have observed a similar discrepancy between ultr asound and per-operative cholangiography (POC), This trial investigate s whether the discrepancy between ultrasound and POC measurements has clinical significance. Method: Seventy-five patients with normal pre-o perative ultrasound and POC undergoing standard open cholecystectomy ( with benzodiazepine pre-medication) in 1990 were identified, After all owance for magnification, maximum biliary diameters were obtained for the proximal extra-hepatic bile duct, Follow-up was obtained in 67 pat ients from clinical case notes and contact with general practitioners. Results: Considerable variation of bile duct distensibility was recor ded (range 83% to 410%) with 12 cases having POC biliary diameters out side radiological guidelines (12 mm as recorded on the radiograph). Th is distension is shown to increase with age, After 4 years, 16 patient s had recurrent abdominal pain of which nine had undiagnosed right upp er quadrant pain, There were no clinical cases of retained stone post- operatively. There was no correlation between POC measured bile duct d iameter or distensibility and post-operative or long term problems. Th is study suggests that the bile duct has a normal variation of distens ibility which increases with age and that radiological guidelines, as regards the upper limit for normal POC biliary diameters, can be relax ed.