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
A. Csendes et al., 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, Hepato-gastroenterology, 45(23), 1998, pp. 1415-1421
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.