ABNORMAL CHOLANGIOGRAMS DURING LAPAROSCOPIC CHOLECYSTECTOMY - IS TREATMENT ALWAYS NECESSARY

Background: Laparoscopic common bile duct exploration (LCBDE) is more expensive and time consuming than its conventional counterpart. Theref ore, ii: should only be performed when there is near certainty that st ones are present. The purpose of this study was to identify patients w ho should be spared LCBDE despite an abnormal intraoperative cholangio gram. Methods: Of 700 consecutive laparoscopic cholecystectomies perfo rmed between 1989 and 1994 by a single surgeon (R.J.F.), 41 had abnorm al intraoperative cholangiograms (6%). All 41 patients were treated by either immediate CEDE (19) (conventional or laparoscopic) or had post operative follow-up cholangiograms (22), The patients were retrospecti vely assigned to one of three groups. Group I patients had a single '' soft'' indicator of choledocholithiasis. Group II patients had one or more of the following: (1) a highly suspicious abnormal intraoperative cholangiogram, (2) two or more ''soft'' indicators of choledocholithi asis, or (3) preoperative clinical findings such as elevated liver fun ction studies or positive preoperative radiological studies. Group III patients had proven choledocholithiasis. Results: In group I, there w ere 11 patients, none of whom underwent immediate CEDE. Eight of the 1 1 (73%) had normal follow-up cholangiograms due to either spontaneous stone passage or a false-positive intraoperative cholangiogram. There were 27 patients in group II; 19 underwent immediate CEDE with 100% st one recovery, The remaining 8 had delayed treatment and in five stones were recovered, while three had normal postoperative cholangiograms s uggesting spontaneous stone passage. In group III, all three had negat ive follow-up cholangiograms despite proven choledocholithiasis. Spont aneous stone passage in this group seemed highly likely. Conclusions: The finding of a single soft indicator results in a low rate of stone recovery postoperatively, and these patients should not undergo LCBDE. In this series, spontaneous stone passage seemed highly likely in at least 3/22 (14%) and possibly as high as 14/22 (64%).