Intraoperative flexible choledochoscopy: Outcomes of 216 cases over 23 years

Objective: Intraoperative flexible choledochoscopy can help in the diagnosis and treatment of various biliary tract diseases by providing direct visualization of the bile ducts. This study discusses the role of choledochoscopy in diagnosing and treating most diseases of the hepato-biliary- pancreatic system particularly in patients in whom laparotomy with or without choledochotomy is planned or performed and in whom ERCP, MRCP, or other advanced techniques are not applied, deficient or unsuccessful. Methodology: Choledochoscopy was performed via a vertical choledochotomy using a flexible choledochoscope during the surgical procedures on the patients, who were operated on because of hepato-biliary-pancreatic system diseases, and the choledochotomy line was closed by primary closure, t-tube application or choledochoduodenal anastomosis. The clinical records of 216 patients over the course of 23 years were retrospectively evaluated. Results: The age range was 19-92 years (mean: 63.1 years), and 139 patients (64.4%) were female. The most common indication included the presence of suspected choledochal stones in 77 patients (35.6%). Additional diagnostic or therapeutic endoscopic procedures (stone or hydatid vesicula removal, biopsy or cytology, balloon dilation, and stent removal or placement) were performed on 106 patients (49.1%). The average choledochoscopy duration was 8.5 minutes (range: 5-25 minutes). Choledochoscopy confirmed the anticipated diagnosis in 98 patients (45.4%), whereas it provided additional unanticipated diagnostic information in 68 (31.5%) patients; the results were normal in 50 patients (23.1%). In the present series, complications occurred in four patients (1.9%), whereas no choledochoscopy-related mortality was observed. Conclusion: Intraoperative flexible choledochoscopy is a safe and useful procedure that can aid in the diagnosis and treatment of various biliary tract diseases.