Which pre-operative findings translate to a positive intra-operative cholangiogram?

Background: The most common investigations used in the pre-operative diagnosis of choledocholithiasis are ultrasound and liver function tests (LFTs). These modalities have a low sensitivity for detecting common bile duct stones amongst the intermediate-risk groups. Aim: Identify pre-operative findings which predict choledocholithiasis in intermediate-risk groups. Describe the implications of a positive intra-operative cholangiogram (IOC). Method: A retrospective study of all consecutive laparoscopic cholecystectomies with IOC performed. Data were collected over two years between 1st January 2015 and 31st December 2016. Standard demographic variables, preoperative symptoms, LFTs, IOC findings, abdomen ultrasound, and postoperative symptoms were included. Results: 23 cases were planned for IOC. The median age was 41 years. Seventeen cases were females. Indications were 12 biliary colic, eight gallstone pancreatitis, two cases of acute cholecystitis, and one case was for ascending cholangitis. Four cases had a positive IOC, and in this group, the median age was 44.5 years with one male. The mean common bile duct diameter was 6.5 mm. Two patients had biliary colic, one patient gallstone pancreatitis and one acute cholecystitis. One patient had a history of jaundice, and all four cases had elevated GGT above 40 mmol/l, three cases had ALP above 98 mmol/l. Post-operative, out of 23 cases, five cases had an ERCP, repeated ultrasound in three cases, persistence symptoms in four cases. Conclusions: GGT was the strongest predictor of choledocholithiasis. A normal GGT seems to be quite good at ruling out CBD stones. ALP was less accurate. Gallstone pancreatitis is not a good predictor, but it is importance to exclude choledocholithiasis before/during cholecystectomy. There is no relation between the IOC and persistent symptoms.

Grantor

Division of General Surgery

Year dc:date.issued

2020

Author dc:creator

• Elmusbahi, Mohamed Ali M

Advisor dc:contributor.advisor

• Kloppers, Christo

• choledocholithiasis
• cholecystectomy
• intraoperative cholangiogram (IOC)

Handle dc:identifier.uri

http://hdl.handle.net/11427/32608

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/32608