IS PREOPERATIVE INTRAVENOUS CHOLANGIOGRAP HY REASONABLE

The need for a routine preoperative intravenous cholangiogram (IVC) ha s been controversely discussed. We decided to assess if preoperative c riteria such as history, clinical examination or laboratory findings c ould be used for selective indication for preoperative IVC. In a serie s of 146 patients with a preoperative IVC before undergoing laparoscop ic cholecystectomy, history, clinical findings and laboratory results (bilirubin, transaminases, alcaline phosphatase, amylase) have been co rrelated with the radiological findings. ERCP was taken as the standar d to assess the value of IVC. A normal IVC was quite reliable in exclu ding any pathology of the bile ducts or common bile duct stones. Thus specificity reached 96% and the negative predictive value was 97%. On the other hand a pathological IVC proved not to be a valid predictor o f true pathological alterations. Sensitivity was only 60% and the posi tive predictive value just 55%. Over all accuracy was quite satisfacto ry (94%). We could not find a correlation between history, clinical or laboratory findings and the final result as assessed by ERCP. Therefo re we could not find any useful parameters to define a selective polic y for indication of preoperative IVC. On the other hand the IVC still proved useful to exclude relevant pathological findings. At the time b eing there is no strong argument for abandoning routine preoperative I VC.