ROUTINE USE OF ULTRASOUND 24 HOURS BEFORE LAPAROSCOPIC CHOLECYSTECTOMY CAN PREDICT THE NEED FOR INTRAOPERATIVE CHOLANGIOGRAM - RESULTS OF A12-MONTH PROSPECTIVE AUDIT

Intraoperative cholangiograms and exploration of the common bile duct (CBD) during laparoscopic cholecystectomy are technically more demandi ng than during open cholecystectomy. This has led to many surgeons usi ng a selective policy for cholangiography, In this study we prospectiv ely assessed whether biliary ultrasound (CBD diameter greater than or equal to 6 mm) or one or more abnormal liver function tests (LFTs) per formed in the 24 hours preoperatively could predict the need for chola ngiography. Forty-five patients were studied (14 male, 31 female), mea n age 47.8 years, All patients with one or both tests abnormal preoper atively (19 patients) underwent intraoperative cholangiograms. Seven C BD stones were identified (16%). There was no evidence of CBD stones i n patients not undergoing cholangiography at a median follow-up of 18 months. In patients with stones, three underwent open CBD exploration, and four underwent endoscopic retrograde choledochopancreatography (E RCP) and sphincterotomy in the early postoperative period without comp lications, CBD diameter 26 mm is a useful predictor of CBD stones, The se may be treated successfully by postoperative ERCP.