Dynamic Changes in the Common Bile Duct After Laparoscopic Cholecystectomy: a Prospective Longitudinal Sonographic Study

 

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Zusammenfassung

Ziel: Bei dieser prospektiven Studie wurde die Dynamik einer möglichen Erweiterung des Gallengangs (CBD) und deren Relevanz bei Patienten nach laparoskopischer Cholezystektomie aufgrund von Gallensteinen untersucht. Material und Methoden: Bei 50 Patienten (36 Frauen, 14 Männer) mit Gallensteinen, die für eine laparoskopische Cholezystektomie vorgesehen waren, wurde eine präoperative Sonografie einen Tag zuvor sowie eine weitere 24 h nach der Operation durchgeführt. Bei allen Patienten wurde der Durchmesser des Gallengangs noch einmal am 7., 90. und 180. Tag nach Cholezystektomie bestimmt. Der Lumendurchmesser wurde knapp unter der Gabelung der Leberäste, auf Höhe des Schnittpunkts der Leberarterie und auf Höhe des Bauchspeicheldrüsenkopfs gemessen. Die Kontrollgruppe bestand aus 50 gesunden Personen (35 Frauen und 15 Männer) mit normalen Labor- und Sonografiebefunden, ohne vorangegangene hepatobiliäre Erkrankungen, klinische Symptome oder Operationen. Ergebnisse: Der durchschnittliche präoperative Durchmesser des CBD an 3 verschiedenen Stellen betrug jeweils 2,27 ± 0,18, 3,49 ± 0,23 und 4,31 ± 0,30. Der durchschnittliche Gallengangsdurchmesser 24 h nach Eingriff und am 7. postoperativen Tag zeigte keine signifikante Veränderung im Vergleich zum präoperativen Befund. 3 Monate nach Cholezystektomie war der CBD an allen 3 Stellen statistisch signifikant erweitert (p < 0,05); 6 Monate nach dem Eingriff blieb der Gallengang im Vergleich zu den voroperativen Befunden am proximalen und distalen Abschnitt signifikant erweitert. Schlussfolgerung: Nach Cholezystektomie zeigt der CBD eine allgemeine Tendenz zu einer leichten, aber signifikanten Dilatation. Die Kenntnis dieses Bildes bei Patienten bis zu 6 Monate nach Gallenentfernung verhindert eine Ultraschall-Fehldiagnose.

Abstract

Purpose: The aim of this prospective study was to assess the dynamics of potential common bile duct (CBD) dilatation and to find the best predictors in patients after laparoscopic cholecystectomy due to gallstones. Materials and Methods: Fifty patients (36 women, 14 men) with gallstones scheduled for laparoscopic cholecystectomy underwent preoperative sonography one day prior to surgery and again within 24 hours of cholecystectomy. In all patients, the diameter of the CBD was measured again on the 7^th, 90^th and 180^th day after cholecystectomy. The luminal diameter was measured just below the bifurcation of hepatic ducts, at the level of intersection with the hepatic artery and at the level of the pancreatic head. The control group consisted of 50 healthy individuals (35 women and 15 men) with normal biochemistry and sonography, and without a history of hepatobiliary disease, clinical symptoms or surgery. Results: The mean preoperative CBD diameter at three locations was 2.27 ± 0.18, 3.49 ± 0.23 and 4.31 ± 0.30, respectively. The mean diameter of the common bile duct measured within 24 hours of surgery and on the seventh postoperative day did not significantly change with respect to the preoperative measurement. Three months after cholecystectomy, the CBD was statistically wider at all three locations (p < 0.05). Six months after cholecystectomy, the CBD remained significantly wider at the proximal and distal part when compared to the preoperative measurements. Conclusion: The CBD showed an overall trend towards a slight, but significant, dilatation after cholecystectomy. The common bile duct dilates significantly 3 months after cholecystectomy. Familiarity with these patterns prevents ultrasound misdiagnosis when examining patients within 6 months of cholecystectomy.

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Dr. Petra Valkovic

Radiology, Clinical Hospital Center Rijeka

Kresimirova 42

51000 Rijeka

Croatia

Phone: ++ 3 85/5 16 58 38 6

Fax: ++ 3 85/5 16 58 38 6

Email: petra.valkovic@ri.t-com.hr