Treatment options of CBD stones include selective pre or postoperative
ERCP, open choledochotomy and one-stage laparoscopic clearance. There
are several disadvantages to ERCP including the additional invasiveness
of endoscopic procedures, moreover large and/or multiple stones, or impacted
stones in CBD may be dyfficult or impossible to retrieve at ERCP
even with ES (endoscopic sphirtcterotomy). Peroperative real time cholangiography
has the advantage of addressing choledocholithiasis with a
single procedure LCBDE (Laparoscopic Common Bile Duct Exploration)
while leaving the sphincter of Oddi anatomically intact without added
morbidity. The choice of treatment between immediate laparoscopic common
bile duct exploration, open exploration of CBE) and trans-sphincteric
endoscopic retrieval depends on many factors.
A prospective study was designed to visualize and examine the biliary
ductal system by laparoscopic infra-operative cholangiography (IOC) during
laparoscopic cholecystectomy (LC).
The aim was to visualize the ductal anatomy and any anomalies on
filling with contrast (to avoid biliary injury), detect any CBD stones and
assess the ductal emptying and patency of ampulla of Vater by immediate
contrast flow through the papilla into the duodenum.
Methods: Intraoperative cholangiography was performed for 302 patients
underwent LC for chronic calcular cholecystids (CCC) in Bertha University
Hospital from Dec. 1999 to Jan. 2004. |
