Korean J Gastroenterol.  2011 Dec;58(6):338-345. 10.4166/kjg.2011.58.6.338.

The Variation of Hepatic Duct Confluence and Asymptomatic Common Bile Duct Stone with Routine Intraoperative Cholangiogram during Laparoscopic Cholecystectomy

• Kim SY
• Kim KH
• Kim ID
• Suh BS
• Shin DW
• Kim SW
• Park JS
• Lim HI

• KMID: 1043333
• DOI: http://doi.org/10.4166/kjg.2011.58.6.338

Abstract

BACKGROUND/AIMS
Intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC) has been used to evaluate bile duct stone. But, the routine use of IOC remains controversial. With routine IOC during LC, we reviewed the variation of hepatic duct confluence and try to suggest the diagnostic criteria of asymptomatic common bile duct (CBD) stone.
METHODS
We reviewed the medical record of 970 consecutive patients who underwent LC with IOC from January 1999 to December 2009, retrospectively.
RESULTS
Nine hundered seventy patients were enrolled. IOC were successful in 957 (98.7%) and unsuccessful in 13 (1.3%). Eighty two of 957 patients (8.2%) were excluded because of no or poor radiologic image. According to Couinaud's classification, 492 patients (56.2%) had type A hepatic duct confluence, 227 patients (26.1%) type B, 15 patients (17%) type C1, 43 patients (4.9%) type C2, 72 patients (8.2%) type D1, 21 patients (2.4%) type D2, 1 patient (0.1%) type E1, 1 patient (0.1%) type E2, 2 patients (0.2%) type F, and 1 patient (0.1%) no classified type. The CBD stone was found in 116 of 970 (12.2%) patients. In 281 patients, preoperative serologic and radiologic tests did not show abnormality. When preoperative findings were not remarkable, there was no difference of clinical features between patients with or without CBD stones.
CONCLUSIONS
Although IOC during LC has some demerits, it is a safe and accurate method for the detection of CBD stone and the anatomic variation of intrahepatic duct.

Keyword

Intraoperative cholangiogram; Laparoscopic cholecystectomy; Intrahepatic bile ducts; Asymptomatic bile duct stone

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Body Mass Index
Cholangiography
*Cholecystectomy, Laparoscopic
Female
Gallstones/*diagnosis/pathology
Hepatic Duct, Common/anatomy & histology/*radiography
Humans
Intraoperative Period
Male
Middle Aged
Retrospective Studies

Figure

• 

  Fig. 1. IOC flow chart. It shows the process of IOC and how to confirm CBD stone defected with IOC. IOC, intraoperative cholangiogram; CBD, common bile duct; LC, laparoscopic cholecystectomy.

• 

  Fig. 2. It is unclassified hepatic duct confluence type.

Reference

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