Prospective trial of the role of fine bore intubation of the cystic duct at the time of operative cholangiography.

BACKGROUND: The incidence of common bile duct calculi in patients selected for laparoscopic cholecystectomy is 4 to 6 percent. Management is controversial. We report our experience with fine bore cannulation of the cystic duct in patients found on operative cholangiography to have common bile duct stones. STUDY DESIGN: We performed a prospective study of 310 patients who underwent laparoscopic cholecystectomy to evaluate the role of fine bore intubation of the cystic duct at the time of operation. Operative cholangiogrphy was attempted on all patients. In 9 patients, the fine bore tube was left in situ for at least 6 weeks. RESULTS: Intubation was found to be safe and well-tolerated. It permitted biliary decompression and allowed repeat cholangiography. Thirty percent of patients had spontaneous clearance of the common duct stones, which was shown on repeat studies. CONCLUSIONS: Fine bore cannulation of the cystic duct is a safe procedure that allows repeat cholangiography, thus eliminating false-positive results. It reduces the need for intervention by demonstrating the spontaneous disappearance of retained calculi in up to a third of cases.