2005 Abstracts: The Indications for Selective Intraoperative Cholangiography Should Include Hyperbilirubinemia or a Dilated Bile Duct and Not Elevated Liver Function Tests or Biliary Pancreatitis
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The Indications for Selective Intraoperative Cholangiography Should Include Hyperbilirubinemia or a Dilated Bile Duct and Not Elevated Liver Function Tests or Biliary Pancreatitis
Ed Livingston, Robert V. Rege, UT Southwestern, Dallas, TX
Background: The criteria used to perform intraoperative cholangiography (IOC) have been uniformly applied without validation. These include a clinical history of jaundice, pancreatitis, elevated bilirubin, abnormal liver function tests, increased amylase, a high lipase or dilated common bile duct (CBD) on preoperative ultrasonography. The predictive power of these criteria for identifying abnormalities has not been established.
Methods: Charts were reviewed for a 6-month time period in 2003 at Parkland Memorial Hospital for all patients undergoing cholecystectomy. Logistic regression followed by univariate analysis was used to determine which factors significantly predicted the presence of choledocholithiasis. Results: There were 572 cholecystectomies performed during the study period. Of these 189 underwent IOC. Of these, 57 were found to have CBD stones. Only a dilated CBD identified with preoperative US [odds ratio ± 95% CI=19.2 (8.0-46.1)] or an elevated total bilirubin [2.8 (1.1-7.3)] were significant predictors for identifying choledocholithiasis. Of the 14 cases where there was a positive IOC without these findings, in only 2 patients was there the possibility for missing potentially clinically significant CBD stones. Conclusion: US identification of a dilated CBD or elevated bilirubin levels can be the sole criteria for the performance of IOC when deciding preoperatively to perform IOC on a selective basis. Reliance on a history of jaundice, pancreatitis or elevations of liver function tests or pancreatic enzymes results in an excessive number of negative IOCs.
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