IMAGING OF THE COMMON BILE-DUCT IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

Options for managing the common bile duct during laparoscopic cholecys tectomy include routine peroperative cholangiography and selected preo perative endoscopic retrograde cholangiopancreatography (ERCP). The us e of these methods was reviewed in 350 patients with symptomatic gall stones referred for laparoscopic cholecystectomy. Unit A (n=114) perfo rmed routine cystic duct cholangiography but undertook preoperative ER CP in patients at very high risk of duct stones only; unit B (n=236) p erformed selected preoperative ERCP on the basis of known risk factors for duct stones. The detection rate for common bile duct stones was s imilar for units A and B (16% v 20%). In unit A, five of seven patient s who had preoperative ERCP had duct stones. Operative cholangiography was technically successful in 90% of patients and duct stones were co nfidently identified in 13, one of whom went on to immediate open duct exploration. Postoperative ERCP identified duct stones in only four p atients, indicating spontaneous passage in eight. In unit B, preoperat ive ERCP was undertaken in 76 of 236 (32%) patients and duct stones we re identified in 47 (20%). Duct clearance was successful in 42 (18%) b ut failed in five (2%), necessitating elective open duct exploration. Both protocols for imaging the common bile duct worked well and yielde d satisfactory short term results.