Operative choledochoscopy in patients with acute cholangitis: a prospective, randomized study.

Area of Science:

• Gastroenterology and Hepatology
• Surgical Innovation
• Biliary Tract Disease Management

Background:

• Acute cholangitis and acute suppurative cholangitis are serious biliary tract infections.
• Conservative management failure necessitates urgent surgical intervention.
• Conventional common bile duct exploration may miss residual stones.

Purpose of the Study:

• To evaluate the safety and efficacy of operative choledochoscopy in emergency surgery for acute cholangitis.
• To compare the incidence of retained common bile duct stones after choledochoscopy versus conventional exploration.
• To assess the impact of choledochoscopy on postoperative complications and mortality.

Main Methods:

• Prospective, randomized evaluation of 157 patients undergoing emergency surgery for acute cholangitis.
• Randomization into two groups: operative choledochoscopy (n=79) and control (conventional exploration, n=78).
• Postoperative assessment included T-tube cholangiography to detect retained stones and monitoring for complications.

Main Results:

• Choledochoscopy did not increase rates of sepsis, pancreatitis, or mortality.
• Significantly reduced incidence of retained common bile duct stones detected by T-tube cholangiography (P < 0.01).
• Choledochoscopy identified 10 stones missed by conventional exploration.

Conclusions:

• Operative choledochoscopy is a safe adjunct to common bile duct exploration in acute cholangitis.
• This technique effectively reduces retained common bile duct stones.
• Choledochoscopy enhances stone clearance and improves management of complex biliary infections.