We have located links that may give you full text access.
The evaluation and management of known or suspected stones of the common bile duct in the era of minimal access surgery.
Surgery, Gynecology & Obstetrics 1993 June
Laparoscopic cholecystectomy (LC) has rapidly become the procedure of choice for symptomatic cholelithiasis. The perioperative diagnosis and modern treatment of suspected stones of the common bile duct (CBD) remains controversial. A database of 573 patients undergoing LC was compiled during an 11 month period. Sixty-seven patients (47 females, 20 males) (13 percent) were suspected of having CBD stones based upon clinical, laboratory and roentgenographic evidence. Fifty-two patients underwent endoscopic retrograde cholangiopancreatography (ER-CP) (45 preoperative and seven postoperative). Seventeen patients were studied with intraoperative cholangiogram (IOC). The indications for cholangiography (either ERCP or IOC) included pancreatitis (group 1), clinical history suggestive of CBD stones, but normal preoperative liver function tests (LFT) (group 2), cholangitis (group 3), grossly abnormal LFT (group 4) and dilated CBD (greater than 7 millimeters on sonogram) (group 5). The incidence of CBD stones was three of 14 (21 percent) in group 1, six of 20 (30 percent) in group 2, two of three (67 percent) in group 3, 16 of 26 (62 percent) in group 4 and two of four (50 percent) in group 5. Overall, 29 patients (23 females and six males) had stones retrieved from the CBD. Of the 52 ERCP, 20 endoscopic sphincterotomies were performed for documented CBD stones. Of the group that had pre-LC ERCP, three (6 percent) ultimately required an open procedure. There were three instances of post-ERCP pancreatitis (6 percent) and ERCP was not able to opacify or clear the CBD in four instances. Seven patients had postoperative ERCP with successful retrieval of retained CBD stones (100 percent). Of the 17 IOC, eight were positive--two patients underwent laparoscopic clearance of the CBD and six required conversion to an open procedure. There were no deaths or extensive complications. Total and direct bilirubin, alkaline phosphatase and serum glutamic pyruvic transaminase were independently related to the presence of a CBD stone, while demographic data, past medical history, preoperative symptoms, leukocyte count, vital signs, amylase, serum glutamic-oxalacetic transaminase nuclear scintigraphic visualization of the duodenum or size of CBD on sonography, were not. No patient with biliary pancreatitis had CBD stones without abnormalities in the LFT or the preoperative sonogram. ERCP is a useful technique to clear the CBD pre-LC. However, ERCP in patients with biliary pancreatitis, but otherwise normal preoperative tests, has a low yield. In this group of patients, IOC is an appropriate alternative to pre-LC ERCP.
Full text links
Related Resources
Trending Papers
Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment.Clinical Research in Cardiology : Official Journal of the German Cardiac Society 2024 April 12
Proximal versus distal diuretics in congestive heart failure.Nephrology, Dialysis, Transplantation 2024 Februrary 30
Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports.Mental Health Clinician 2023 October
World Health Organization and International Consensus Classification of eosinophilic disorders: 2024 update on diagnosis, risk stratification, and management.American Journal of Hematology 2024 March 30
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app