Intraoperative Endoscopic Retrograde Cholangiopancreatography Research Articles

Preoperative, Intraoperative, and Postoperative Imaging Techniques for Diagnosis Leading to the Treatment of Common Bile Duct Stones.

All patients undergoing laparoscopic or open cholecystectomy are potentially harboring common bile duct (CBD) stones. Because laparoscopic cholecystectomy imposes a greater challenge for managing choledocholithiasis, the tests chosen to evaluate the CBD must consider the ability of the surgeon to manage these stones. Those who are skilled at laparoscopic CBD exploration or intraoperative endoscopic retrograde cholangiopancreatography (ERCP) may take the traditional approach of intraoperative cholangiography. Those who are not skilled at intraoperative management of choledocholithiasis, or for that matter laparoscopic intraoperative cholangiography, must carefully plan when and how to determine the presence of CBD stones. Preoperative imaging techniques include biochemical tests, plain film of the abdomen, oral cholecystography, ultrasonography (US), endoscopic US, intravenous cholangiography, ERCP, percutaneous transhepatic cholangiography, choledochoscopy, computed tomography, radioisotope imaging, and magnetic resonance imaging. Intraoperative imaging techniques include intraoperative US, intraoperative cholangiography, choledochoscopy, ERCP, and endoluminal US. Postoperative imaging techniques include preoperative techniques plus T-tube cholangiography and T-tube choledochoscopy.

Laparoscopic choledochoscopy and extraction of common bile duct stones.

Various strategies have been proposed for the treatment of common bile duct stones encountered during laparoscopic cholecystectomy (LC). Eighty-three patients who had choledocholithiasis discovered during or just prior to LC are included in this study. These patients were treated by various modalities including preoperative, intraoperative, and postoperative endoscopic retrograde cholangiopancreatography and sphincterotomy, laparoscopic choledochotomy, transcystic duct-common bile duct (TCD-CBD) exploration, and conventional "open" common duct exploration. Sixty-six patients were successfully treated with TCD-CBD exploration. They were discharged on average 2.6 days postoperatively and were able to return to normal physical activities within 7 days of discharge. There was minimal morbidity and no mortality. The technique of TCD-CBD exploration is described in detail. The role of laparoscopic choledochotomy and endoscopic sphincterotomy for management of common duct stones in patients undergoing laparoscopic cholecystectomy appears limited.

Diagnosis and management of common bile duct stones in patients with sickle hemoglobinopathies

Nine of 35 patients with sickle hemoglobinopathies and cholelithiasis were found to have concomitant common bile duct (CBD) stones. We describe the diagnosis and management of these patients with CBD stones. Historical information, physical examination, and routine laboratory tests were unable to identify accurately the patients with CBD stones. Similarly, ultrasonography of the hepatobiliary system was an insensitive method for detecting CBD stones, as only 3 of 8 patients were correctly identified. In contrast, both an intraoperative cholangiogram and endoscopic retrograde cholangiopancreatography were sensitive procedures for detection of CBD stones. We conclude that CBD stones are relatively common in patients with sickle cell disease and cholelithiasis, and clinicians should have a high index of suspicion for their presence.