Abnormal intraoperative cholangiography. Treatment options and long-term follow-up.

OBJECTIVE: To determine the long-term outcome in patients with filling defects on intraoperative cholangiography. DESIGN: Case series; retrospective review. SETTING: Community teaching hospital. PATIENTS: All patients (n = 872) undergoing cholecystectomy from July 1993 through June 1995. Of 281 intraoperative cholangiograms performed, 89 had abnormal findings. Defects were classified as stone (n = 47), unsure (n = 29), and artifact (n = 13). Medical records were reviewed for immediate and long-term follow-up results. INTERVENTION: Need for common bile duct exploration (CBDE) or endoscopic retrograde cholangiopancreatography (ERCP). OUTCOME: Morbidity and interventions required 1 to 3 years after surgery. RESULTS: Of the 47 patients with suspected stones, 24 underwent successful operative bile duct clearance. One patient required irrigation. Of the 22 patients who left the operating room with unresolved stones, only 2 ERCPs were required. Of the 29 patients with unsure filling defects, operative clearance was successful in 1; irrigation achieved clearance in 4. Only 1 of the 24 patients who left the operating room with unsure filling defects required subsequent ERCP. CONCLUSIONS: Observation of common bile duct defects of 4 mm or smaller is an appropriate clinical alternative. Defects of 5 mm or larger represent a gray area, although few 5- to 8-mm stones will cause subsequent symptoms. In our experience, if stone extraction is clinically important, especially if the patient has jaundice, open CBDE is more effective than transcystic laparoscopic CBDE.

Duke Scholars

Author Suresh Kumar Agarwal Jr. Trauma, Acute, and Critical Care Surgery