PREOPERATIVE EVALUATION OF THE PROBABILITY OF COMMON BILE-DUCT STONES

BACKGROUND: This study was done to determine if certain criteria could predict the presence of common bile duct stones in patients with symp tomatic gallstones. It was hoped that patients could be identified in whom intraoperative cholangiography was unnecessary. STUDY DESIGN: One hundred seventy-five patients, from 15 surgical centers, were prospec tively enrolled, For each patient, the preoperative score (Huguier sco re) previously published was calculated according to clinical and ultr asound data: age, diameter of the common bile duct, diameter of the sm allest gallstone, history of biliary colic, and acute cholecystitis. A ll patients underwent an open cholecystectomy and an intraoperative ch olangiography. The absence or presence of a common bile duct stone was evaluated during the operation, if necessary, after an instrumental i nvestigation of the common bile duct. RESULTS: Ultrasound was not inte rpretable in eight (5 percent) of 175 patients. Final analysis was; ma de from the charts of the 167 remaining patients, Thirty (18 percent) had common bile duct stones, When the score was equal to or greater th an 3.5, the risk of having a common bile duct stone was 24 percent (27 of 111), When the score was less than 3.5, this risk was 5 percent (t hree of 56), CONCLUSIONS: Huguier's score is well assessed and can be safely used. Intraoperative cholangiography could be avoided in 33 per cent of patients when the score is less than 3.5 (56 of 167).