PREVALENCE OF COMMON BILE-DUCT STONES ACCORDING TO THE INCREASING NUMBER OF RISK-FACTORS PRESENT - A PROSPECTIVE-STUDY EMPLOYING ROUTINELY INTRAOPERATIVE CHOLANGIOGRAPHY IN 477 CASES

BACKGROUND/AIMS: To determine if the use of Intraoperative choliangiog raphy (IOC) should be routinely performed and, if not, which criteria should be used to select patients requiring IOC during open or laparos copic cholecystectomy. METHODOLOGY: 495 Patients with 1 or more gallst ones were included in a two-year study. Twelve clinical, laboratory, u ltrasonographic and intraoperative factors were chosen and evaluated i n all cases. Prior to cholecystectomy, IOC was performed after having identified the common bile duct (CBD) and cystic duct. The majority of the patients were operated on by the same surgeon to avoid difference s in criteria and techniques. Statistical evaluation made use of the e xact Fisher test and chi square test and, a p-value less than 0.05 was considered as significant. RESULTS: IOC could be performed in 479 out of the 495 cases. IOC resulted in a normal CBD in 76.0%, had a false positive in 2.7%, a false negative in 0.48%, and a presence of 1 or mo re stones in the CBD kin 20.9%. The study revealed that when none of t he 12 risk factors were present, there were no cases with CBD stones. As the number of risk factors increased, so did the number of cases pr esenting with CBD stones. CONCLUSION: Not all 12 risk factors show the same index of predictability; only 5 in particular (jaundice, ultraso und diameter CBD 7mm, bilirubin over 26 umol/it, cystic duct > 4 mm an d CBI, diameter over 9 mm) showed a high rate of predictability. Howev er, when careful measurement and evaluation of risk factors for CBD st ones are undertaken, it is possible to avoid the routine use of IOC.