N-OTC is associated with shorter operative time and fewer peri-operative complications , and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy .
R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones .
The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical , biochemical or radiological features suggestive of CBD stones .
INTRODUCTION The aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography ( R-OTC ) versus no on-table cholangiography ( N-OTC ) in patients undergoing cholecystectomy .
Does selective peroperative cholangiography result in missed common bile duct stones?
A prospect i ve r and omized trial was undertaken to determine if selective peroperative cholangiography result ed in greater morbidity and mortality from missed common bile duct ( CBD ) stones . Five hundred and thirty-nine consecutive cholecystectomies were performed over a 3-year period . Two hundred and fifty-four had indications for m and atory peroperative cholangiography and were excluded from the trial . The remaining 285 patients , without a history of jaundice , pancreatitis or abnormal liver function tests , were r and omized blindly into two groups . Group 1 underwent peroperative cholangiography ( PC ) and group 2 did not . If the surgeon found a dilated CBD at surgery then these patients were also excluded from the trial . Selective peroperative cholangiography revealed an unsuspected CBD calculus in 16 of the 132 patients ( 12 % ) . Up to the time of review no patient from group 2 presented with symptoms or complications from retained CBD stones . One patient in group 1 had endoscopic removal of a retained CBD calculus 16 months after cholecystectomy . All patients were sent a question naire at least three years after surgery and 210 responded ( 74 % ) . One hundred and thirty ( 62 % ) of the respondents had  peroperative cholangiography .  There were 11 deaths from unrelated causes . No difference between the two groups was found for postoperative dietary habit , dyspepsia , pain , flatulence , diarrhoea or signs of biliary obstruction . It seems from these results that a policy of selective cholangiography in our h and s may miss a 12 % incidence of unsuspected stones but , importantly , this does not appear to influence postoperative morbidity or mortality . ( ABSTRACT TRUNCATED AT 250 WORDS
N-OTC is associated with shorter operative time and fewer peri-operative complications , and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy .
R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones .
The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical , biochemical or radiological features suggestive of CBD stones .
INTRODUCTION The aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography ( R-OTC ) versus no on-table cholangiography ( N-OTC ) in patients undergoing cholecystectomy .