Routine or selective intraoperative cholangiography in laparoscopic cholecystectomy. J Laparoendosc Surg 1993 Feb;3(1):27-33
Date
02/01/1993Pubmed ID
8453125DOI
10.1089/lps.1993.3.27Scopus ID
2-s2.0-0027512578 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
The routine versus selective use of intraoperative cholangiography has been the subject of debate for some time. Most authors currently advocate routine intraoperative cholangiography with laparoscopic cholecystectomy. The authors report their experience with the selective and routine utilization of intraoperative cholangiography at two institutions. At institution A, 155 laparoscopic cholecystectomies were attempted, and 21 cholangiograms were performed (based on preoperative criteria of ultrasound, liver function tests, and history of jaundice, or intraoperative anatomical uncertainty). At institution B, 164 laparoscopic cholecystectomies were attempted and 127 cholangiograms were performed (a routine intraoperative cholangiography policy). At institution A, there were no common bile duct injuries but there was one retained stone. At institution B, there was one common bile duct injury and no retained stones. The patient with the retained stone from institution A had a preoperative indication (total bilirubin = 4.4 mg/dl) for a cholangiogram, but it was not performed due to technical difficulties. This patient later required endoscopic sphincterotomy with stone extraction. One patient at institution B had a choledochotomy which was detected by intraoperative cholangiography (IOC). This was managed with a T-tube. The selective use of cholangiograms in laparoscopic cholecystectomy will not yield a higher incidence of common bile duct injuries or retained stones compared to routine use. Further, a cholangiogram may not necessarily prevent choledochotomy but can prevent extension of common bile duct injury. Thus, it should always be performed when there is anatomic uncertainty.
Author List
Carlson MA, Ludwig KA, Frantzides CT, Cattey RP, Henry LG, Walker AP, Schulte WJ, Wilson SDAuthor
Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Cholangiopancreatography, Endoscopic RetrogradeCholecystectomy, Laparoscopic
Common Bile Duct
Gallstones
Humans
Intraoperative Care
Intraoperative Complications
Sphincterotomy, Endoscopic
