[Routine preoperative cholangiopancreatography?]

Since the early 50s, the routine use of operative cholangiography in biliary surgery has decreased the rate of negative choledochotomy and retained stones. In the last twenty years no further progress has occurred and negative choledochotomy rate remains at 30% and for retained stones at 1.3%. Modern endoscopic technology has improved the diagnosis and treatment of biliary diseases so we think that the routine use of endoscopic retrograde cholangiopancreatography (ERCP) as a preoperative study for patients to be surgically treated of biliary disease can reduce the incidence of negative choledochotomies, retained stones and duodenostomies that are the most important sources of biliary surgery complications. The results of ERCP as routine preoperative study in patients with diagnosis of symptomatic gallstones selected for surgical treatment are discussed. From June 1988 to June 1989 56 patients who filled the requirements were included. Ultrasound scan, laboratory test. EKG and complete digestive studies were performed at admission. ERCP was done immediately before surgery. Abnormalities on biliary tract were seen in 10 cases (17.9%). Six (10.7%) had stones in the common duct, in 4 of these patients (7.1%) the lithiasis was unsuspected, Four cases (7.1%) had dilated ducts, three of them with narrowing of the distal end of the choledochus. In 5 cases with duct stones and 3 with dilated ducts an endoscopic sphincterotomy was performed at the same time of the study, stones were withdrawn and biliary system cleared before laparotomy. Only one choledochotomy was done in a patient with a carcinoma of the gallbladder and a big stone impacted in cystic duct that produced compression of the common bile duct (Mirizzi Syndrome).(ABSTRACT TRUNCATED AT 250 WORDS)