Experience with Peroperative Choledochoscopy

Overview

Introduction:
Choledocholithiasis is nowadays managed endoscopicaly in the majority of patients. Open surgery with CBD exploration remains important, when endoscopy failed. The completeness of stones‘ extraction may be confirmed with choledochoscopy.

Method:
The retrospective analysis of patients operated on choledocholithiasis within the period of seven years was performed. Two groups of patients were studied. First group was managed by choledocholithotomy followed by choledochoscopy. Second group underwent exploration of the common bile duct without choledochoscopy. Frequency of the residual stones in both groups was studied. Statistical evaluation was done using α² test. The value of p < 0.05 was settled as statistically significant.

Results:
In the study period of seven years 46 patients were operated on CBD stones. Choledocholithotomy followed by intra-operative choledochoscopy was performed in 21 patients. No remnant stones were recorded in this group. Exploration of the CBD with stone extraction without choledochoscopy was done in 25 patients. In this group residual stones occurred in 3 patients. The result was not statistically significant, p = 0.10.

Conclusions:
According to our experience and literature, intra-operative choledochoscopy can reduce frequency of the residual CBD stones. Peroperative choledochoscopy can thus be recommended as an accessory procedure to CBD exploration to prevent stones oversight.

Key words:
choledocholithiasis – peroperative choledochoscopy – remanent lithiasis