Selective per-operative cholangiography and scoring method for selection

Abstract

A prospective clinical study was undertaken over a period of 3 years on a series of 210 consecutive cases of gall stones to review a selective policy for per-operative cholangiography (PC). All patients had elective cholecystectomy and routine PC. A scoring method (SM) based on pre and per-operative surgical criteria was adopted to determine the necessity of PC before this was attempted. The study revealed that PC was indicated in 64 cases (30.5%) only. Of these 64 patients 20 had abnormal cholangiograms of which 18 proved positive on exploration. There were two false positive results (0.95%) of PC but no false negative result. Of 146 patients (69.5%) not clinically indicated for routine PC, 145 had normal cholangiograms and one had a small (5 mm diameter) silent stone (0.47%) in the Common Bile Duct (CBD). The scoring method failed to predict this case of silent stone. PC was technically unsatisfactory in 4 cases (1.9%). Thus by adopting the selective policy X-rays could have been avoided in 69.5% cases in which only a small silent stone would have been overlooked. However, this stone could have passed into the duodenum spontaneously or else it could have been removed by endoscopic sphincterotomy had it caused any symptoms. It is concluded that routine PC is not always necessary, a selective policy may be preferred and a scoring method may be used as a guide for selection of the cases.