Cholecystocholangiography vs cystic duct cholangiography during laparoscopic cholecystectomy

Abstract

Intraoperative cholangiography performed during laparoscopic cholecystectomy provides an exact picture of the biliary anatomy. It may prevent iatrogenic bile duct injury and detect unsuspected common duct stones. Laparoscopic cannulation of the cystic duct can be difficult and time-consuming. We therefore evaluated the simpler technique of cholecystocholangiography by direct puncture and filling of the gallbladder with contrast medium. This technique was compared with cystic duct cholangiography in a prospective controlled trial of 69 patients. Cystic duct cholangiography (n = 38) showed significantly better results than cholecystocholangiography (n = 31) with optimal visualization of the biliary tree in 29 cases (76%) and seven cases (22%), respectively. The failure rate was 8% and 52%, respectively. Delineation of the cystic duct junction is important in order to prevent bile duct injury. The anatomy in this region was clearly delineated in 34 cases (89.5%) using cystic duct cholangiography but only in 11 cases (35.5%) with cholecystocholangiography. Cystic duct cholangiography revealed unsuspected common duct stones in three cases; however, choledocholithiasis was missed by cholecystocholangiography in at least two patients. Cystic duct cholangiography is clearly the optimal technique. In situations of unclear anatomy in which safe dissection of the cystic duct is not possible, cholecystocholangiography remains a useful alternative.

Intraoperative assessment of biliary anatomy for prevention of bile duct injury: a review of current and future patient safety interventions

“…Also, CCC yielded inferior image quality and a 2.3 times longer radiation exposure. In comparative studies, Daoud et al [59] reported comparable success rates for CCC and IOC, while Glattli et al [60] found a very low success rate of 36% for CCC versus 90% in IOC. In general, success rates CCC series vary between 72 and 90% [61–64].…”

Prospective randomized comparison of laparoscopic ultrasonography using a flexible-tip ultrasound probe and intraoperative dynamic cholangiography during laparoscopic cholecystectomy

“…Furthermore, due to catheter perforations, transection of the cystic duct, or shortness of the cystic duct, the safe closure of the cystic stump can be hampered by the IOC itself. According to Glättli et al, the technically simpler and safer means of contrasting the bile ducts by laparoscopic cholecystocholangiography yields significantly poorer results; thus, it cannot be regarded as an alternative to transcystic cholangiography [8].…”

Cholecystocholangiography During Laparoscopic Cholecystectomy

“…1,2,5,7,8,12,14 The failure rates associated with cystic duct cholangiography have been reported to range from An alternative to performing cholangiography is cholecystocholangiography, although this has been criticized for frequently yielding inadequate common bile duct opacification. [15][16][17] On the other hand, satisfactory cholangiograms using laparoscopic cholecystocholangiography have been reported in 80%-92% of patients with chronic or acute calculous cholecystitis, without any complications or false-positive findings. 4,8,10 In the present study, the biliary tree anatomy was clearly demonstrated in 90% of the 40 patients with symptomatic gallstones or chronic calculous cholecystitis.…”