Laura Meiler, DO1, Justin Gusching, DO1, Dwayne North, DO1, Courtney Pisano, DO1, Kristen Conrad-Schnetz, DO2, Christian Massier, MD1. 1South Pointe Hospital, 2Metro Health
Introduction: Intraoperative cholangiography (IOC) may detect residual stones in the common bile duct (CBD) after acute biliary pancreatitis (ABP). The aim of the present study is to analyze the utility of IOC in detecting residual stones in patients undergoing cholecystectomy for ABP and if complications are related with this procedure.
Case Description: Demographic and clinical factors were assessed in patients with ABP who underwent IOC during laparoscopic cholecystectomy. Factors assessed included preoperative size of the CBD on ultrasonography, presence of stones in the gallbladder and the CBD, and IOC results. For the statistical analysis, χ2 or Fisher's exact tests to compare proportions and the nonparametric Mann-Whitney U test for analysis of values with abnormal distribution were used.
Discussion: The study included 579 patients. All preoperative laboratory indicators were elevated. The laboratory tests do not demonstrate any statistical significance between these two groups. The group of the patients without stones in the CBD diagnosed by IOC was also divided in patients with diameters <0.8?mm and with diameters ≥0.8?mm of the CBD. Also in these two groups, the statistical analysis of the laboratory tests does not demonstrate significant difference. All patients underwent IOC. IOC showed stones in 84/113 patients (74.3%). A comparison of patients with and without stones at IOC showed similar mean times from hospitalization to surgery (5.9?days [range 2-12?days] vs. 6.1?days [range 2-23?days]), from surgery until hospital discharge (2.0?days [range 0-4?days] vs. 2.2?days [range 0-11?days]), and overall length of stay (7.9?days [range 3-19?days] vs. 8.3?days [range 3-23?days]) (P > 0.001).
Conclusion: IOC is rarely useful to diagnose residual CBD stones, without increasing complications related to the procedure itself. It can be safely avoided if other preoperative imaging procedures for the bile ducts have ruled out biliary malformations.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86351
Program Number: P079
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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