Summary
This study assessed the ability of biochemical tests and ultrasound to predict the presence of ductal calculi, and thereby refine the indications for ERCP, in patients before or after laparoscopic cholecystectomy. Thirteen of fifty-three patients investigated before laparoscopic cholecystectomy, and four of seventeen investigated after had stones confirmed at ERCP. The most sensitive indices for stones were raised serum alkaline phosphatase (0.76), aspartate transferase (0.75) and alanine transferase (0.76). The most specific indices were an abnormal ultrasound (0.92), raised serum amylase (0.78) and raised bilirubin (0.75). Serum bilirubin, amylase and ultrasound were all normal in twenty-seven patients and all of these had normal ERCPs. If patients with normal bilirubin, amylase and ultrasound were not referred for ERCP, no stones would have been overlooked and the number of ERCPs could have been reduced by 39%.
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Grace, P. A., Quereshi, A., Coleman, J., et. al. Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br. J. Surg. 1991; 78; 160–2.
Nathanson, L. K., Shimi, S., Cushieri, A. Laparoscopic cholecystectomy: the Dundee technique. Br. J. Surg. 1991; 78: 155–9.
Paterson-Brown, S., Garden, O. J., Carter, D. C. Laparoscopic cholecystectomy. Br.J. Surg. 1991; 78: 131–2.
Cameron, J. L., Gadacz, T. R Laparoscopic cholecystectomy. Ann. Surg. 1991; 213; 1–2.
Wastell, C. Laparoscopic cholecystectomy. Br. Med. J. 1991; 302: 302–3.
Schirmer, B. D., Edge, S. B., Dix, J. et al. Laparoscopic cholecystectomy treatment of choice of symptomatic cholelithiasis. Ann. Surg. 1991; 213: 665–76.
Dubois, F., Icard, P., Berthelot, G., Levard, H. Celioscopic cholecystectomy. Preliminary report of thirty-six cases. Ann. Surg. 1991; 211: 60–3.
Peters, J. H., Ellison, E. C., Innes, J. T., et al. Safety and efficacy of laparoscopic cholecystectomy. Ann. Surg. 1991; 213: 3–12.
The Southern Surgeons Club. A prospective analysis of 1518 laparoscopic cholecystectomies.N Eng J Med 1991; 324: 1973–8.
Graves, H. A., Ballinger, J. F., Anderson, W. J. Appraisal of laparoscopic cholecystectomy. Ann. Surg. 1991; 213: 655–62.
Gerber, A. A requiem for the routine operative cholangiogram. Surg. Obst. Gynecol. 1986; 163: 363–4.
Scott-Coombes, D., Thompson, J. Bile duct stones and laparoscopic cholecystectomy. Br. Med. J. 1991; 303: 1281–2.
McEntee, G., Grace, P. A., Bouchier-Hayes, D. Laparoscopic cholecystectomy and the common bile duct. Br. J. Surg. 1991; 78: 385–6.
Wilson, T. G., Hall, J. C., Watts, J. McK. Is operative cholangiography always necessary? Br J. Surg. 1986; 73: 637–40.
Thompson, J. N. Laparoscopic cholecystectomy. Br. Med. J. 1991; 302: 533.
Boulay, J., Schellenberg, R., Brady, P. G. The role of ERCP and therapeutic biliary endoscopy in association with laparoscopic cholecystectomy. Am. J. Gastroenterol. 1992; 87: 837–42.
Marotta, F., Hada, R., Morello, P. et al. ERCP in the assessment of patients with post-cholecystectomy syndrome: benefits and limitations. Netherlands J. of Med. 1989; 35: 232–40.
Rosselano, A. R., Osnes, M. Biliary concrements: the endoscopic approach. World J. Surg. 1989; 13: 178–85.
Cotton, P. B. Critical appraisal of therapeutic endoscopy in biliary tract diseases. Ann. Rev. Med. 1990; 41:21 1–22.
Yip, A. W. C., Ng, W. S., Chow, W. C. et al. Plea for selective operative cholangiography. J. R. Coll. Surg. Edinb. 1991; 36: 21–4.
Joyce, W. P., Keane, R., Burke, G. J. et al. Identification of bile duct stones in patients undergoing laparoscopic cholecystectomy. Br. J. Surg. 1991; 78: 1174–6.
Bailey, R. W., Zucker, K. A., Flowers, J. L., et al. Laparoscopic cholecystectomy. Experience with 375 consecutive patients. Ann. Surg. 1991; 214; 531–41.
Berci, G., Sackier, J., Phillips, E. et al. Laparoscopic cholecystectomy. Anomalies and bile duct injuries. World Congress of Surgery, Stockholm 1991: 142.
Ponsky, J. L. Complications of laparoscopic cholecystectomy. Am. J. Surg. 1991: 161: 393–5.
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Quershi, A., Browne, A., Leahy, A.L. et al. ERCP in the management of patients having laparoscopic cholecystectomy: Re-Appraising current indications. I.J.M.S. 162, 510–512 (1993). https://doi.org/10.1007/BF03022585
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DOI: https://doi.org/10.1007/BF03022585