Ak. Sharma et al., A RANDOMIZED TRIAL OF SELECTIVE OR ROUTINE ON-TABLE CHOLANGIOGRAPHY, Annals of the Royal College of Surgeons of England, 75(4), 1993, pp. 245-248
To assess the value of pre- and peroperative indicators of common bile
duct (CBD) stones, 167 patients undergoing cholecystectomy were rando
mised to receive either routine (R) or selective (S) on-table cholangi
ography (OTC). In all, 81/84 patients in the R group and 22/78 in the
S group had OTCs (P<0.0001). In the R group 11/81 were positive (one f
alse-positive) and in the S group 7/22 were positive (P < 0.05). CBD s
tones were present in 10/81 in the R group and 7/78 in the S group (P
= NS). In the R group 8/10 and in the S group 5/7 had CBD stones diagn
osed preoperatively by ultrasound scanning (USS), giving USS a positiv
e predictive value (PPV) of 100% and a sensitivity of 71.4% in the S g
roup. A raised preoperative alkaline phosphatase (ALP) was found in 1/
10 in the R group and 117 in the S group (PPV = 33.3%, sensitivity = 1
4.3%). In the R group 1/10 and in the S group 1/7 (PPV = 25%, sensitiv
ity = 14.3%) were found to have a dilated CBD during operation suggest
ing CBD stones. There have been no cases of symptomatic unsuspected re
tained CBD stones during follow-up to date. Our study has demonstrated
that selective use of OTCs can be safely employed in open cholecystec
tomies. Over 85% (6/7 in the S group and 15/17 overall) of CBD stones
can be diagnosed preoperatively by USS and liver function tests, with
USS having the greatest PPV and sensitivity.