The necessity and development of a new modified scoring system for simultaneous detection of common bile duct stones in patients with planned laparoscopic cholecystectomy

Abstract

Introduction: Choledocholithiasis is one of the undesirable consequences of gallbladder stones. Identifying such patients before cholecystectomy will prevent biliary leakage which develops secondarily to stones in the common bile duct (CBD). Scoring systems can be useful for prevention of complications. Material and methods: A total of 201 patients with symptomatic cholecystolithiasis were prospectively evaluated with regards to stone presence in the CBD. These evaluations identified those patients suspected of having CBD stones. Parameters were established as clinically obstructive jaundice or acute cholangitis attack, biochemically abnormal liver functions tests (LFT), radiological identification of CBD stone or choledochal dilatation (> 8 mm) as revealed by ultrasonography (USG). Residual stone controls were conducted through abdominal USG and LFT in the 3rd and 6th postoperative months. The patients’ physical examinations were routinely conducted at each follow-up. Patients with common bile duct stones and those without were statistically compared as per the following data: age, sex, cholangitis, g-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), Aspartate aminotransferase (AST), alanine aminotransferase (ALT), cholesterol, triglyceride, total bilirubin, direct bilirubin, CBD stone presence and choledochal size as revealed by USG. Results: The parameters of our scoring system were: choledocholithiasis and choledochal dilatation in USG, total and direct bilirubin elevation, cholangitis episode in the last month, elevated AST, ALT, ALP, GGT, age ≥ 55 and TG level. Twenty-seven patients had choledocholithiasis. With this scoring system, the minimum score required for preoperative ERCP was 9. The rate of simultaneous CBD stones was 13.4%. Conclusions: Selective cholangiography that uses this scoring system brings about more cost utility than that of its routine performance.