Routine cholangiography reduces sequelae of common bile duct injuries

Abstract

Routine cholangiography did not appear to decrease the absolute incidence of bile duct injuries compared to previously published reports. Injury severity, morbidity, late sequelae, and costs were reduced by a policy of routine cholangiography.

Iatrogenic bile duct injuries

“…In a series of 118 BDI, Woods et al [20] observed that in 17 of 33 patients (51.5%) submitted to IOC, the diagnosis of injury was made during the intraoperative period, the operation was converted, and primary repair was performed. Carroll et al [8] reported that 11 of 12 injuries in their series (91.6%) were recognized by the routine use of IOC. Rosenthal et al [15] observed that 80% of BDI are diagnosed during the intraoperative period when IOC is used routinely, whereas 50% are identified when IOC is used selectively.…”

“…Several investigators have reported that the incidence of this type of injury is higher than that observed with open surgery [6,8,17]. The higher incidence of BDI during LC has been attributed to many factors, including limited experience of the operating surgeon with laparoscopic techniques, inability to obtain good exposure of the structures of the hepatocystic triangle, and poor visualization of the anatomy of the biliary tract when observed through the laparoscope.…”

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

“…Surgeons must understand the nuances of interpretation if they are going to perform the technique and obtain an experienced opinion when unsure [63,88]. Whether IOC in LC should become routine will continue to remain a contentious issue.…”

Acute biliary pancreatitis, endoscopy, and laparoscopy

“…The risk of biliary injury is increased in complex cases, including biliary pancreatitis, operated on laparoscopically. IOC has been shown to be associated with a reduction of this risk [20,21] and to shorten the delay for the diagnosis of biliary injury [10,73].…”