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 1：1.53, 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.
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