CLINICAL RESEARCH
The necessity and development of a new modified scoring system for simultaneous detection of common bile duct stones in patients with planned laparoscopic cholecystectomy
 
 
 
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1
Department of Gastroenterological Surgery, University of Health Sciences, Kartal Koşuyolu High Specialized Training and Research Hospital, Istanbul, Turkey
 
2
Department of General Surgery, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
 
 
Submission date: 2019-07-28
 
 
Acceptance date: 2019-08-25
 
 
Publication date: 2019-11-21
 
 
Arch Med Sci Civil Dis 2019;4(1):89-96
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Choledocholithiasis is one of the undesirable consequences of gallbladder stones. Identifying such patients before cholecystectomy will prevent biliary leakage which develops secondarily to stones in the common bile duct (CBD). Scoring systems can be useful for prevention of complications.

Material and methods:
A total of 201 patients with symptomatic cholecystolithiasis were prospectively evaluated with regards to stone presence in the CBD. These evaluations identified those patients suspected of having CBD stones. Parameters were established as clinically obstructive jaundice or acute cholangitis attack, biochemically abnormal liver functions tests (LFT), radiological identification of CBD stone or choledochal dilatation (> 8 mm) as revealed by ultrasonography (USG). Residual stone controls were conducted through abdominal USG and LFT in the 3rd and 6th postoperative months. The patients’ physical examinations were routinely conducted at each follow-up. Patients with common bile duct stones and those without were statistically compared as per the following data: age, sex, cholangitis, γ-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), Aspartate aminotransferase (AST), alanine aminotransferase (ALT), cholesterol, triglyceride, total bilirubin, direct bilirubin, CBD stone presence and choledochal size as revealed by USG.

Results:
The parameters of our scoring system were: choledocholithiasis and choledochal dilatation in USG, total and direct bilirubin elevation, cholangitis episode in the last month, elevated AST, ALT, ALP, GGT, age ≥ 55 and TG level. Twenty-seven patients had choledocholithiasis. With this scoring system, the minimum score required for preoperative ERCP was 9. The rate of simultaneous CBD stones was 13.4%.

Conclusions:
Selective cholangiography that uses this scoring system brings about more cost utility than that of its routine performance.

REFERENCES (25)
1.
NIH consensus conferance. Gallstones and laparoscopic cholecystectomy. JAMA 1993; 269: 1018-24.
 
2.
Maingot’s Abdominal Operations. 9th Edition. Zinner MJ, Schwartz SI, Ellis H (eds). Vol. 2. Appleton & Lange, International Edition, Connecticut 1990; 1337-478.
 
3.
Sungler P, Heinerman PM, Mayer F, Boeckl O. Laparoscopic cholecystectomy in cholecysto-choledocholithiasis. “Therapeutic splitting” or conventional surgical procedure? Chirurg 1993; 64: 1012-7.
 
4.
Damjanov I, Linder J. Anderson’s Pathology. 10th Edition, Mosby, St. Louis 1996; 1869-75.
 
5.
Bezzi M, Silecchia G, Orsi F, et al. Complications after laparoscopic cholecystectomy. Coordinated radiologic, endoscopic, and surgical treatment. Surg Endosc 1995; 9: 29-36.
 
6.
Franceschi D, Brandt C, Margolin D, et al. The management of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Am Surg 1993; 59: 525-32.
 
7.
Morris PJ, Wood WC. Oxfort Textbook and Surgery. 2nd Edition. Vol. 2. Oxfort Univercity Press, New York 2000; 1663-710.
 
8.
Sarli L, Iusco DR, Roncoroni L. Preoperative endoscopic sphincterotomy and laparoscopic cholecystectomy for the management of cholecystocholedocholithiasis: 10-year experience. World J Surg 2003; 27: 180-6.
 
9.
Sarli L, Pietra N, Franzé A, et al. Routine intravenous cholangiography, selective ERCP, and endoscopic treatment of bile duct stones before laparoscopic cholecystectomy. Gastrointest Endosc 1999; 50: 200-8.
 
10.
Menezes N, Marson LP, DeBeaux AC, Muir IM, Auld CD. Prospective analysis of a scoring system to predict choledocholithiasis. Br J Surg 2000; 87: 1176-81.
 
11.
Schafer M, Krahenbuhl L, Buchler MW. Diagnosis and treatment of common bile duct stones: a current review and the Berne concept. Schweiz Med Wochenschr 1999; 129: 624-30.
 
12.
Charfare H, Cheslyn-Curtis S. Selective cholangiography in 600 patients undergoing cholecystectomy with 5-year follow-up for residual bile duct stones. Ann R Coll Surg 2003; 85: 167-73.
 
13.
Masci E, Fanti L, Mariani A, et al. Selection criteria for pre-operative endoscopic retrograde cholangiography and endoscopic-laparoscopic treatment of biliary stones. Eur J Gastroenterol Hepatol 1999; 11: 781-4.
 
14.
The Rome Group for Epidemiology and Prevention of Cholelithiasis. The epidemiology of gallstone disease in Rome, Italy. Part II. Factors associated with the disease (GREPCO). Hepatology 1988; 8: 907-13.
 
15.
Tang WH. Serum and bile lipid levels in patients with and without gallstones. J Gastroenterol 1996; 31: 823-7.
 
16.
Cameron JL. Current Surgical Therapy. 7th edition. Mosby Inc, St. Louis 2001; 399-480.
 
17.
Mo LR, Chang KK, Wang CH, Yau MP, Yang TM. Preoperative endoscopic sphincterotomy in the treatment of patients with cholecystocholedocholithiasis. J Hepatobiliary Pancreat Surg 2002; 9: 191-5.
 
18.
Rijna H, Kemps WG, Eijsbouts Q, Meuwissen SG, Cuesta MA. Preoperative ERCP approach to common bile duct stones: results of a selective policy. Dig Surg 2000; 17: 229-33.
 
19.
Nataly Y, Merrie AE, Stewart ID. Selective use of preoperative endoscopic retrograde cholangiopancreatography in the era of laparoscopic cholecystectomy. ANZ J Surg 2002; 72: 186-9.
 
20.
Csendes A, Burdiles P, Diaz JC, et al. Prevalence of common bile duct stones according to the increasing number of risk factors present. A prospective study employing routinely intraoperative cholangiography in 477 cases. Hepatogastroenterology 1998; 45: 1415-21.
 
21.
Himal HS. Common bile duct stones: the role of preoperative, intraoperative, and postoperative ERCP. Semin Laparosc Surg 2000; 7: 237-45.
 
22.
Hunt DR. Common bile duct stones in non-dilated bile ducts? An ultrasound study. Australas Radiol 1996; 40: 221-2.
 
23.
Thumbe VK, Dorricott NJ. Investigation of bile ducts before laparoscopic cholecystectomy. JSLS 1999; 3: 23-5.
 
24.
Thornton DJ, Robertson A, Alexander DJ. Laparoscopic cholecystectomy without routine operative cholangiography does not result in significant problems related to retained stones. Surg Endosc 2002; 16: 592-5.
 
25.
Uomo G, Rabitti PG, Laccetti M, et al. The role of clinical, biochemical and echographic data in identifying the biliary pathogenesis of acute pancreatitis. Recenti Prog Med 1992; 83: 206-9.
 
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