ROUTINE PREOPERATIVE INFUSION CHOLANGIOGRAPHY AT ELECTIVE CHOLECYSTECTOMY - A PROSPECTIVE-STUDY IN 694 PATIENTS

The role of preoperative infusion cholangiography (PIG) before electiv e cholecystectomy has yet to be defined, Between 1985 and 1991 PIC was performed routinely in 694 patients with median (range) age of 52(17- 85) years with biliary calculus disease 1 or 4 days before elective ch olecystectomy. Satisfactory opacification of the biliary system was ac hieved in 90.1 per cent and mild to moderate adverse reactions to the infusion of contrast medium occurred in 0.9 per cent of patients, Pero perative cholangiography (POC) in 43 of 499 patients with a normal PIC was normal, The presence of common bile duct stones was confirmed in 34 of 36 patients with prominent stones at bile duct exploration and i n 8 of 26 with suspected stones at PIG. Bile duct dilatation (median d iameter 10 mm) without concomitant stones was seen at PIC and confirme d at POC in 20 patients, Bile duct anomalies were found or suspected i n 35 patients at PIC and were confirmed in sis by POC (n=5), or during the cholecystectomy making the anomaly incidence 0.9 per cent. Inform ation provided hy the PIC was not of crucial importance for safe execu tion of cholecystectomy in any patient, while a single (minor) bile du ct lesion (I of 694; 0.1 per cent) could br ascribed to severe pericho lecystitis. The results of this study suggest that routine PTC Is not warranted, However, PIC Is an alternative to selective preoperative en doscopic retrograde cholangiography or selective POC. PIC needs to be supported by POC in approximately 20 per cent of patients (in case of absent or poor opacification of the bile ducts or suspicion of stones or anomalies at PIG).