Cholecystectomy without Operative Cholangiography.

Abstract

Background:: Cholelithiasis is a very common condition whiich may be complicated by the presence ssessing the ability of non-invasive test as useful predictors of Common Bile Duct of common bile duct stones (Choledocholithiasis). This prospective descriptive study was aimed at assessing the ability of non-invasive test as useful predictors of Common Bile Duct Stones (CBDS) in a resource limited environment. The Setting was a hospital-based cohort over a six year period in Jos University Teaching Hospital, Jos, Nigeria. Methods: A total of 40 consecutive patients (16 males and 24 females), aged between 12 and 67 years with gall bladder stones; 7 of whom had clinical, morphologic and biologic indices of CBDS underwent open cholecystectomy wiithout operative cholangiography. Selection of patients for common bile duct exploration can be achieved using the three predictive criteria (clinical, morphologic and biologic) where facilities for intraoperative cholangiography are not available. A short and dilated cystic duct, a dilated common bile duct and/or palpable common bile duct stones found at surgery are complementary predictive indices. Results: The overall prevalence of CBDS was 17.5%. The prevalence was 15% in patients over 50 years of age and 2.5% in patients under 50 years of age. In those over 60 years, it was 5%. Age and the existence of jaundice, recurrent low grade fever and abdominal pain were found to be associated with CBDS. Serum bilirubin, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were increased 7.8, 1.6, 2.95 and 3.85 times beyond their average normal reference values. The mean CBD diametter was 1.74cm. All CBDS were palpated at operation. Serum amylase was normal in all our patients including those with CBDS. All patients who had gall bladder stones but no CBDS had normal serum bilirubin, aspartate aminotransaminase, alanine aminotransaminase and alkaline phosphatase. They also had no jaundiice, fever, abdominal pain or a dilated CBD and/or CBDS. Conclusiion: Evaluation of patients at risk for choledocholithiasis can be achieved with safety using clinical, sonographic and biologic parameters. Such parameters might contribute to reducing unnecessary costly or invasive investigations and help rationalize the diagnostic strategy for choledocholithiasis in countries with limited resources.