Laparoscopic Cholecystectomy Without Intraoperative Cholangiography

Abstract

The low BDI rate in our series allowed us to recommend an LC procedure without an IOC. Performing a cholangiogram either routinely or selectively is not wrong. However, adherence to a meticulous hemostatic technique, thorough knowledge of the anatomy, and a low threshold for conversion may also enable satisfactory results to be achieved.

Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study

“…Other authors have reported similar series without IOC [15][16][17][38][39][40][41][42][43][44][45]. Our study included 2,714 cases, which, to our knowledge, represented the largest reported series of LC without IOC.…”

“…Our study included 2,714 cases, which, to our knowledge, represented the largest reported series of LC without IOC. Other series had fewer cases and only seven [15][16][17][38][39][40][41] exceeded 1,000 cases, ranging from 1,027 up to 2,038 cases. Those are the main studies with which we compared our study.…”

“…Bile duct injuries ranged from 0.0 to 0.60% for series of LC without IOC [15][16][17][38][39][40][41][42][43][44][45], from 0.0 to 0.63% for series with a selective IOC policy [13,14], and from 0.0 to 0.68% for series with a routine IOC policy [6,7,22,23].…”

“…Another policy that has not been discussed enough in the literature is performing LC without resorting to IOC. Due to different reasons such as financial constraints, disadvantages of IOC, and doubt of some authors about its advantages, many centers are currently performing LC without IOC, provided that every effort is done preoperatively to find those patients who are more likely to harbor silent bile duct stones [15][16][17]. Those patients are directed to other therapeutic options such as preoperative endoscopic sphincterotomy and duct clearance before LC or single-stage cholecystectomy and bile duct exploration, whether open or laparoscopic.…”

Bile Duct Injury during Laparoscopic Cholecystectomy without Intraoperative Cholangiography: A Retrospective Study on 1,100 Selected Patients

“…On the other hand, surgeons who adopt the selective implementation of IOC state that only one third of asymptomatic CBD stones need intervention [36]. In the scientific literature there are several articles that have reported a similar series without IOC [37][38][39][40][41].…”