Intraoperative cholangiography and bile duct flushing in 47 dogs receiving laparoscopic cholecystectomy for benign gallbladder disease: A retrospective analysis

Abstract

Objective To describe a laparoscopic approach for performing intraoperative cholangiography (IOC) and bile duct flushing (BDF) during laparoscopic cholecystectomy (LC) in dogs. To investigate the clinical outcomes of dogs undergoing these procedures for the treatment of benign gallbladder disease, ie gallbladder mucocele (GM) or cholecystitis. Study design Retrospective study. Animals Forty‐seven client‐owned dogs. Methods Medical records of client‐owned dogs with benign gallbladder diseases that underwent IOC and BDF during LC between September 2016 and December 2019 were reviewed. Of these dogs, only dogs with GM or cholecystitis were included in the study. The fundus dissection first method was used for LC. Intraoperative cholangiography and BDF procedures were performed laparoscopically using a catheter inserted into the cystic duct following dissection within the subserosal layer of the gallbladder. Videos recorded during each procedure were reviewed, and data on procedure duration, completion, outcome, and technical approach were recorded. Results Forty‐seven dogs were included in the study. The median procedure time for BDF and IOC was 4 min (range, 2‐48 min), and no intraoperative or postoperative complications occurred. Conclusion During LC, BDF and IOC were performed safely and successfully. Intraoperative cholangiography identified obstructions and strictures in the common bile duct that were not detected using BDF alone. Clinical significance Our findings suggest that BDF and IOC are both safe and time effective and should be considered for routine use by surgeons during LC.

Long-Term Outcome after Cholecystectomy without Common Bile Duct Catheterization and Flushing in Dogs

“…Laparoscopic cholecystectomy is a well-established procedure in human medicine and is increasingly advocated for use in dogs [ 17 , 19 , 20 , 21 , 22 ].…”

“…The use of LC has been reported in dogs for benign gallbladder diseases, such as gallbladder mucocele, cholelithiasis and cholangiohepatitis or for dogs that do not have evidence of extrahepatic biliary obstruction [ 17 , 19 , 22 ]. Assessment of extrahepatic biliary obstruction under laparoscopy is difficult in dogs, and confirmation of patency of the CBD is not commonly reported [ 20 , 21 , 22 ]. In human medicine, this is performed, if necessary, using intraoperative cholangiogram under laparoscopic and fluoroscopic guidance [ 18 , 20 , 21 ].…”

“…Assessment of extrahepatic biliary obstruction under laparoscopy is difficult in dogs, and confirmation of patency of the CBD is not commonly reported [ 20 , 21 , 22 ]. In human medicine, this is performed, if necessary, using intraoperative cholangiogram under laparoscopic and fluoroscopic guidance [ 18 , 20 , 21 ]. Indications include an unclear biliary anatomy, a concern for choledocholithiasis or a concern for bile duct injury [ 18 ].…”

“…Laparoscopic cholecystectomy (LC) is considered the gold-standard treatment for gall bladder removal in humans [ 18 ]. This minimally invasive approach has been described in dogs as treatment for uncomplicated GBM without evidence of biliary tract rupture or obstruction [ 17 , 18 , 19 , 20 , 21 , 22 ]. During LC, the patency of the CBD cannot be easily assessed; therefore, appropriate case selection in dogs is important before undertaking this minimally invasive approach.…”

“…Factors that may indicate the need for conversion to an open cholecystectomy have not been identified [ 22 ]. Perioperative complications [ 22 ] and short-term outcomes [ 20 , 21 ] have been described; however, there is limited long-term data on dogs undergoing cholecystectomy without CBD flushing. The aim of this study was to describe long-term outcomes of dogs undergoing traditional open cholecystectomy for GBM without catheterization and flushing of the CBD.…”