Contribution of intraoperative biliary manometry for the diagnosis of bile duct stones

Sixty patients with cholecystitis and gallstones, with and without biliary duct calculi, were submitted to intraoperative biliary manometry and cholangiography. The patients were subdivided into two groups of 30: Group A, without biliary duct calculi, and Group B, with biliary duct calculi. The pathology had been diagnosed before surgery for 24 patients in group B (B1), and for 6 (B2), diagnosis was made on the basis of intraoperative manometry which showed higher pressure values than those encountered in the main bile ducts of patients without calculi, and of intraoperative cholangiography. Choledocotomy, which was performed on all 6 patients, confirmed the presence of calculi. When three successive sequences of pressure measurements were performed on the common bile duct of patients with biliary duct stones there was an increase in pressure at 10, 15 and 20 s from the first compared to the third sequence. Intraoperative manometry suggested the presence of biliary duct calculi, which was confirmed by intraoperative cholangiography in the 20% of patients in group B for whom calculi had not been previously diagnosed, and decreased unnecessary choledocotomy.