Operative choledochoscopy. Results of a prospective study in several institutions

Area of Science:

• Hepatobiliary Surgery
• Gastroenterology
• Surgical Endoscopy

Background:

• Biliary calculi (stones) in the common bile duct present diagnostic and therapeutic challenges.
• Traditional exploration methods may have limitations in detecting all residual stones.
• The role of choledochoscopy as an adjunct to standard procedures requires evaluation.

Purpose of the Study:

• To evaluate the efficacy of choledochoscopy combined with primary choledocholithotomy and cholangiography.
• To assess the incidence of unsuspected residual biliary calculi.
• To determine the value of choledochoscopy in common bile duct exploration and management of biliary tract tumors.

Main Methods:

• A prospective study involving six surgical units.
• Utilized choledochoscopy in conjunction with primary choledocholithotomy and cholangiography.
• Employed a rigid Berci-Shore choledochoscope for routine common duct exploration.

Main Results:

• Achieved an incidence of less than 2% for unsuspected residual biliary calculi.
• Demonstrated that reliance solely on choledochoscopy without cholangiography is not justified.
• Showcased choledochoscopy's ability to shorten exploration time and confirm negative findings, aiding in calculus extraction and identifying coexisting neoplasms.

Conclusions:

• Incorporating choledochoscopy into routine common bile duct exploration is warranted.
• The combined approach significantly reduces residual biliary calculi.
• Choledochoscopy offers value in confirming negative explorations, extracting stones, and managing complex biliary pathologies.