Predictive Variables of Choledocholithiasis in Patients Undergoing Laparoscopic Cholecystectomy

Kim, Jae Seon; Kwon, Oh Sang; Choi, Chang Won; Yim, Hyung Joon; Jeung, Gil Man; byun, Kwan Soo; Choi, Sang Yong; Bak, Young Tae; Kim, Jin Ho; Kim, Jong Guk

Abstract

BACKGROUND AND AIMS: Accurate preoperative prediction of choledocholithiasis is essential in order to minitnize patients risk and to avoid unnecessary procedures. We preforme 1 this study identify independent risk factors for choledocholithiasis in patients who had undergone cholecystectomy for symptomatic cholelithiasis.
METHODS
The medical records of patients who had undergone cholecystectomy between Septernber, 1993 and December, 1996 were reviewed. Patients who were already found to have either extrahepatic or intrahepatic hiliary stones on sonogram were excluded. 79 of these patients in whom the presence or absence of choledocholithiasis had been confirmed (preoperative ERCP in 69, operative choangiography in 10) were eligible for analysis. Candidate predictor variables included age, sex, presence of fever, and maximum preoperative values for each of the followings: common bile duct (CBD) diarneter, white blood cell counts, AST, ALT, alkaline phosphatase, total bilirubin, and amylase. The analysis was conducted using SPSS (V 5.0.2).
RESULTS
Choledocholithiasis was confirmed in 16 (20.3%) of the 79 eligible patients. Univariate analysis identified age, alkaline phosphatase, and CBD diameter as predictors. Multivariate analysis subsequently identified alkaline phosphatase and CBD diamet=r as independent predictors of choledocholithiasis. The probability of choledocholithiasis was 86% when two independent predictors were present, but was 3/o when all two predictors were absent.
CONCLUSIONS
ERCP or operative cholangiography is not thought to be necessary for patients with symptomatic cholelithiasis who have both normal biliary tree on sonogram and normal serum alkaline phosphatase. However patients with syrnptomatic cholelithiasis who have both dilated CBD on sonogram and elevated serum alkaline phosphatase, or are found to have CBD stone on abdominal sonogram, do necessarily require do not necessarily reqine what? RCP? To confirm the presence of CBD stone.