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|Title: ||Cholecystectomy without Operative Cholangiography.|
|Authors: ||Sule, A. Z.|
Peter, S. D.
|Issue Date: ||2011|
|Publisher: ||East and Central African Journal of Surgery|
|Series/Report no.: ||Vol.16;No.2: Pp 103-1081|
|Abstract: ||Background: Choleliithiasis is a very common condition which may be complicated by the
presence assessing the ability off non-invasive test as useful predictors off Common Bile Duct off
common bile duct stones (Choledocholithiasis). This prospective descriptive study was aimed at
assessing the ability off non-invasive test as useful predictors off Common Bile Duct
Stones (CBDS) in a resource limited environment. The Setting was a hospital-based cohort
over a six year period in Jos University Teaching Hospital, Jos, Nigeria.
Methods: A total off 40 consecutive patients (16 males and 24 females), aged between 12 and 67
years with gall bladder stones; 7 off whom had clinical, morphollogic and biologic indices off
CBDS underwent open cholecystectomy without operative cholangiography. Selection of
patients for common bile duct exploration can be achieved using the three predictive criteria
(clinical, morphologic and biologic) where facilities for intraoperative cholangiography are not
available. A short and dilated cystic duct, a dilated common bile duct and/or palpable common
bile duct stones found at surgery are complementary predictive indices.
Results: The overall prevalence off CBDS was 17.5%. The prevalence was 15% in patients over
50 years off age and 2.5% in patients under 50 years off age. In those over 60 years, it was 5%.
Age and the existence off jaundice, recurrent low grade fever and abdominal pain were found to
be associated with CBDS. Serum bilirubin, aspartate aminotransferase, alanine
aminotransferase and alkaline phosphatase were increased 7.8, 1.6, 2.95 and 3.85 times beyond their average normal reference values. The mean CBD diameter was 1.74cm. All CBDS were palpated at operation. Serum amylase was normal in all our patients including those with
CBDS. All patients who had gall bladder stones but no CBDS had normal serum bilirubin,
aspartate aminotransaminase,, alanine aminotransaminase and alkaline phosphatase. They also
had no jaundice, fever, abdominal pain or a dilated CBD and/or CBDS.
Conclusion: Evaluation off patients at risk for choledocholithiasis can be achieved with safety
using clinical, sonographic and biologic parameters. Such parameters might contribute to
reducing unnecessary costly or invasive investigations and help rationalize the diagnostic
strategy for choledocholithiasis in countries with limited resources.|
|ISSN: ||2073 9990|
|Appears in Collections:||Surgery|
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