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A randomised trial of selective or routine on-table cholangiography
A K Sharma1, R Cherry, J W Fielding
1Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham.
Annals of the Royal College of Surgeons of England
|July 1, 1993
Summary
Selective on-table cholangiography (OTC) is safe for open cholecystectomies. Ultrasound scanning (USS) and liver function tests effectively diagnose common bile duct (CBD) stones preoperatively, with USS showing high accuracy.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Diagnostic Imaging
Background:
- Common bile duct (CBD) stones pose a diagnostic challenge during cholecystectomy.
- Preoperative and intraoperative indicators are crucial for accurate diagnosis and management.
Purpose of the Study:
- To evaluate the efficacy of routine versus selective on-table cholangiography (OTC) in patients undergoing cholecystectomy.
- To assess the value of preoperative indicators, including ultrasound scanning (USS) and alkaline phosphatase (ALP) levels, in diagnosing CBD stones.
Main Methods:
- A randomized controlled trial involving 167 patients undergoing cholecystectomy.
- Patients were assigned to either routine (R) or selective (S) on-table cholangiography (OTC).
- Preoperative ultrasound scanning (USS) and alkaline phosphatase (ALP) levels were analyzed.
Main Results:
- Selective OTC was employed in fewer patients (22/78) compared to routine OTC (81/84).
- Ultrasound scanning demonstrated high positive predictive value (100%) and sensitivity (71.4%) for CBD stone diagnosis in the selective group.
- No symptomatic retained CBD stones were reported during follow-up.
Conclusions:
- Selective use of on-table cholangiography (OTC) is a safe and effective strategy in open cholecystectomies.
- Preoperative diagnosis of common bile duct (CBD) stones can be reliably achieved using ultrasound scanning (USS) and liver function tests, with USS being particularly valuable.