PROSPECTIVE TRIAL OF THE ROLE OF FINE BORE INTUBATION OF THE CYSTIC DUCT AT THE TIME OF OPERATIVE CHOLANGIOGRAPHY

BACKGROUND: The incidence of common bile duct calculi in patients sele cted for laparoscopic cholecystectomy is 4 to 6 percent. Management is controversial. We report our experience with fine bore cannulation of the cystic duct in patients found on operative cholangiography to hav e common bile duct stones. STUDY DESIGN: We performed a prospective st udy of 310 patients who underwent laparoscopic cholecystectomy to eval uate the role of fine bore intubation of the cystic duct at the time o f operation. Operative cholangiography was attempted on all patients. In 9 patients, the fine bore tube was left in situ for at least 6 week s. RESULTS: Intubation was found to be safe and well-tolerated. It per mitted biliary decompression and allowed repeat cholangiography. Thirt y percent of patients had spontaneous clearance of the common duct sto nes, which was shown on repeat studies. CONCLUSIONS: Fine bore cannula tion of the cystic duct is a safe procedure that allows repeat cholang iography, thus eliminating false-positive results. It reduces the need for intervention by demonstrating the spontaneous disappearance of re tained calculi in up to a third of cases.