PMID- 22000195
OWN - NLM
STAT- MEDLINE
DCOM- 20111202
LR  - 20161125
IS  - 1532-7361 (Electronic)
IS  - 0039-6060 (Linking)
VI  - 150
IP  - 4
DP  - 2011 Oct
TI  - To 'gram or not'? Indications for intraoperative cholangiogram.
PG  - 810-9
LID - 10.1016/j.surg.2011.07.062 [doi]
AB  - BACKGROUND: The purpose of this study was to evaluate the current practice 
      patterns and results for use of intraoperative cholangiogram (IOC) during 
      laparoscopic cholecystectomy (LC). METHODS: We performed a retrospective review 
      of all patients who underwent LC between January 1, 2005 and December 31, 2009. 
      Data variables included: preoperative laboratory and radiographic studies, 
      indication for and findings of IOC, and perioperative management of 
      choledocholithiasis and retained common bile duct (CBD) stones. RESULTS: There 
      were 1,308 patients who underwent LC by 23 surgeons, of whom 266 also had an IOC 
      (20%) performed. The majority had ultrasonography performed, 242 had an abdominal 
      compute tomography (CT) scan, and 129 patients had a hepatobiliary iminodiacetic 
      acid (HIDA) scan. Indications for an IOC included: diagnosis of 
      choledocholithiasis or gallstone pancreatitis (n = 116), abnormal liver function 
      tests (n = 187), and a dilated CBD >/= 10 mm (n = 182). Of the 266 IOCs, 36 
      patients (13.5%) had a CBD stone with the majority (n = 26; 72%) having normal 
      preoperative imaging studies. Only 6 patients (17%) with a CBD calculi on IOC 
      underwent successful clearance of the calculi at the time of LC. Twenty-nine of 
      the remaining 30 patients with a retained calculus on IOC underwent postoperative 
      endoscopic retrograde cholangiopancreatography (ERCP) with extraction of the 
      calculi. Of the 1,042 LCs performed without an IOC, 31 patients (3%) were 
      diagnosed with a retained stone managed successfully by ERCP. CONCLUSION: Our 
      data reveals that the selective use of IOC is helpful in diagnosing and clearing 
      CBD calculi, that the use of preoperative CBD size aids in selecting patients for 
      IOC, and that choledocholithiasis identified with IOC or after discharge can be 
      managed successfully with ERCP.
CI  - Copyright (c) 2011 Mosby, Inc. All rights reserved.
FAU - Tabone, Lawrence E
AU  - Tabone LE
AD  - Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
FAU - Sarker, Sharfi
AU  - Sarker S
FAU - Fisichella, Piero M
AU  - Fisichella PM
FAU - Conlon, Molly
AU  - Conlon M
FAU - Fernando, Emil
AU  - Fernando E
FAU - Yi, Sophia
AU  - Yi S
FAU - Luchette, Fred A
AU  - Luchette FA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cholangiography/*methods
MH  - Cholangiopancreatography, Endoscopic Retrograde
MH  - Cholecystectomy, Laparoscopic/*methods
MH  - Choledocholithiasis/diagnosis/surgery
MH  - Cholelithiasis/diagnosis/diagnostic imaging/*surgery
MH  - Female
MH  - Humans
MH  - Intraoperative Care/methods
MH  - Male
MH  - Middle Aged
MH  - Practice Patterns, Physicians'
MH  - Retrospective Studies
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
MH  - Ultrasonography
EDAT- 2011/10/18 06:00
MHDA- 2011/12/13 00:00
CRDT- 2011/10/18 06:00
PHST- 2011/02/25 00:00 [received]
PHST- 2011/07/18 00:00 [accepted]
PHST- 2011/10/18 06:00 [entrez]
PHST- 2011/10/18 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
AID - S0039-6060(11)00417-X [pii]
AID - 10.1016/j.surg.2011.07.062 [doi]
PST - ppublish
SO  - Surgery. 2011 Oct;150(4):810-9. doi: 10.1016/j.surg.2011.07.062.