Assessment of Requirement of Routine Intraoperative Cholaniography at Cholecystectomy

Introduction: Retained choledochal stones are classified as the stones that were left at the time of surgery or diagnosed shortly after the cholecystectomy. Choledochal stones may be silent and often are discovered incidentally. They may cause obstruction, complete or incomplete, or they may manifest themselves with cholangitis or gallstone pancreatitis. Therefore, this study was designed to determine frequency of retained chledochal stones and its relationship with some variables such as age, gender, serum alkaline phosphatase, serum bilirubin, ultrasound findings, MRC and ERC. Methods: This is a cross-sectional study that was done on 200 patients who underwent cholecystectomy with sequential pattern during 2012 in the Shahid Sadooghi Hospital of Yazd. The study data were collected according to the patients' history, physical examination, files and also one month follow up. Moreover, the data were analyzed by SPSS software ver.17. Results: From 200 patients who underwent cholecystectomy, only one patient (0.5%) had retained choledochal stone. Before cholecystectomy, 19 patients (9.5%) who were presumed to have choledochal stone, underwent ERCP. In 16 patients (8%) sphincterotomy and stone extraction were done. From these 16 patients,14 patients (87.5%) had high level of serum alkaline phosphatase, 12 patients (75%) had high level of serum bilirubin and 9 patients (56.3%) had abnormal ultrasound findings during preoperative course. Thus, there was a statistically significant relation between these three variables and choledochal stone. Conclusion: According to above statistically significant relation, we recommend that in patients who are candidate for cholecystectomy, if elevated preoperative serum alkaline phosphatase or elevated preoperative serum bilirubin or abnormal ultrasound findings were observed, more diagnostic evaluation should be done for them including MRC and ERC