Avtor/Urednik		Vračko, Jožef; Wicchel, Karl-Ludvig
Naslov		The laparoscopic finding of pericholedochitis at cholecystectomy predicts the presence of unsuspected bile duct stones
Tip		članek
Vir		Surg Laparosc Endosc Percut Techn
Vol. in št.		Letnik 10, št. 3
Leto izdaje		2000
Obseg		str. 120-6
Jezik		eng
Abstrakt		Routine laparoscopic cholangiography and sonography have been recommended for identification of unsaspected bile duet stones in laparoscopic cholecystectomy. The mereased prevalence of retained stones scems, however, to confirm that cholangiography has been used rather selectively. The aim of this study was to investigate the kind and extent of a possible correlation between inflammatory changes in the bile duct mucosa and the hepatoduodenal ligament in patients with and without unsuspected bile duct stones. Sixty-eight patients, without symptoms or signs or bile duet stones in their case histories, laboratory findings, and preoperative sonography results, underwent laparoscopie cholecystectomy for symptomatic gallstone disease and diagnostic transcystic cholangiography and cholangioscopy. The initial step at laparoscopy revealed edema of the periductal loose tissue, vascular dilation, and petechiae on the external surface of the distal portion of the extrahepatic bile duct in 47 of 68 patients. Cholangioscopy revealed inflammatory changes in the mucosa of the distal and sphineteric portions of the extrahepatic bile duct in 45 of 47 patients and unsuspected ductal stones were identified in 41 of these 45 patients. Neither the external surface of the bile duct nor its mucosa exhibited any signs of inflammation in the 21 remaining patients (controls), all of whom showed stone-free bile ducts. Inflammatory changes in the bile duct mucosa, occurring along with unsuspected mobile ductal stones in this study, were reflected on the external surface of the bile duct with a specificity of 87%. The changes in the external surface of the bile duct can be recognized at the initial inspection in laparoscopic cholecystectomy as in this study, and indicate that more accurate diagnostic procedures to identify unsuspected ductal stones should be used.
Deskriptorji		CHOLANGIOGRAPHY CHOLECYSTECTOMY, LAPAROSCOPIC CHOLELITHIASIS CHOLANGITIS COMMON BILE DUCT DISEASES BILE DUCTS, EXTRAHEPATIC