Cervantes J, Rojas GA

Language: Spanish
References: 22
Page: 35-40
PDF size: 102.01 Kb.

ABSTRACT

Objective: To study the use of operative cholangiography in 20 years of personal surgical practice
Design: Retrospective, longitudinal
Setting: Third level health care hospital
Patients and methods: All cases of patients with gallbladder surgery operated by the author during a period of twenty years, the first 10 years with open surgery, the last 10 with laparoscopy. We studied the indications and number of operative cholangiographies and explorations of the bile ducts as well as the frequency of negative explorations, residual common bile duct stones, morbidity and mortality
Results: In the period of open surgery, following the traditional criteria, operative cholangiography was done in 88% of the cases, resulting in exploration of the bile ducts in 24%, with 47% negative explorations. No morbidity, mortality and no residual stones were observed in this period. In the era of laparoscopic surgery, with more strict criteria, operative cholangiography was done in 4% of the cases and exploration of the bile ducts in 2%, without morbidity and mortality and only one case of residual common bile duct stone (0.18%).
Conclusions: Routine cholangiography is not justified in the average patient contemplating cholecystectomy for cholelithiasis. With no history of jaundice or pancreatitis, normal liver function tests and normal size common bile duct by ultrasound, the chances of leaving a residual stone in the biliary ducts are less than 0.5%. The traditional criteria for operative cholangiography and bile duct exploration should be revised to avoid the large number of negative common bile duct explorations.

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