The Role of Intraoperative Choledochoscopy for Diagnosis and Treatment in Biliary Surgery

ABSTRACT

PURPOSE: A choledochoscopy is useful for treating stone disease in the biliary tract. In the era of laparoscopic surgery, this method is expected to be used more widely. Its use during surgery may not only aid disease treatment, but may also help in making a differential diagnosis and a decision on the appropriate operative method. The aim of this study was to determine the role of intraoperative choledochoscopy in biliary surgery. METHODS: This study was a prospective analysis for 119 cases of biliary surgery where a choledochoscopy was used at the Ewha Womans University Mokdong Hospital from June, 1999 to February, 2001. An attempt was made to determine if the use of choledochoscopy altered the preoperative diagnosis, added another diagnosis and influenced the surgical treatment. In addition, the frequency of the remnant stones in biliary stone disease, and the complications related with this procedure were evaluated. RESULTS: The male to female ratio was 11.53, and the mean age was 61.1 (+/-14.53) years. A choledochoscopy was used in 82 cases (69%) in open surgery, and 37 cases (31%) in laparoscopic surgery. In 31 cases (26.1%), the diagnosis was changed by the choledochoscopic findings. In 9 cases (7.5%), new finding that was not recognized in the preoperative state was added with the use of choledochoscopy. The surgical method was influenced by the use of a choledochoscopy in 39 cases (32.8%). The remnant stones in patients with an intrahepatic duct stone and common bile duct stone were detected in 8 cases and 3 cases, respectively. The respective clearance rate of the stones were 79.5% (31/39) and 94.5% (52/55). There was no complications and side effects associated with the use of choledochoscopy. The mean time for diagnostic use was 14.6 (+/-10.0) minutes and for therapeutic use was 47 (+/-60.4) minutes. CONCLUSION: Intraoperative choledochoscopy provided useful information for a precise diagnosis and assisted in determining the appropriate treatment for biliary disease. Furthermore, it is very important for making a differential diagnosis in patients with an undetermined malignancy.