SELECTIVE CHOLANGIOGRAPHY WITH LAPAROSCOPIC CHOLECYSTECTOMY - REVIEW OF A PROTOCOL

Objective: To report the results of a protocol for the preoperative di agnosis of stones in the common bile duct in patients with symptomatic cholelithiasis.Design: Prospective open study. Setting: District gene ral hospital, United Kingdom. Interventions: Ultrasonography and liver function tests, and in selected patients preoperative cholangiography . Main outcome measures: The ability of the investigations to diagnose stones in the common bile duct preoperatively. Results: Ultrasonograp hy or liver function tests, or both indicated that 53 patients were at low risk of having stones in the common duct, and they underwent lapa roscopic cholecystectomy without further investigation. A further 38 p atients had minor abnormalities on the first two investigations and un derwent intravenous cholangiography; ductal stones were identified in 6. Nine patients were thought to be at high risk and so underwent endo scopic retrograde cholangiopancreatography (ERCP) or open exploration of the common bile duct, and stones were found in 5. No further stones have been identified after a minimum follow up of 12 months. Conclusi on: Selective preoperative cholangiography is a reliable way of detect ing stones in the common bile duct before laparoscopic cholecystectomy .