Selective operative cholangiography in the performance of laparoscopic cholecystectomy

Abstract

The objective of this prospective study was to evaluate the role of intraoperative cholangiography (IOC) for patients undergoing laparoscopic cholecystectomy (LC) to determine whether it could be safely omitted for all patients who fit standard criteria, namely normal liver function tests, no history of gallstone pancreatitis, common bile duct (CBD) diameter less than 10 mm or previous history of jaundice. Data were collected prospectively from 194 consecutive patients who had LC for symptomatic gall bladder disease. IOC was not performed in any patient. The conversion rate was 6.1% and one CBD injury occurred. Our experience demonstrates that LC performed without routine IOC does not result in an increased incidence of retained stones in selected patients who have no history of pancreatitis, normal liver function tests and CBD less than 10 mm diameter.

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

“…Those are the main studies with which we compared our study. Other similar studies did not exceed 413 cases and were not considered for comparison [42][43][44][45]. Conversion rate, including cases of acute cholecystitis, was 2% in our series, which is favorably comparable to that of most of other series (up to 8%), except for Mir et al [17] who reported a conversion rate of 1.8%.…”

“…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.…”

“…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].…”

Is Perioperative Cholangiography Necessary in Children Undergoing Elective Laparoscopic Cholecystectomy?

“…This patient was found to have stones at ERC. Similarly, McFarlane et al [9] reported on 194 patients who underwent LC without IOC, based on similar preoperative parameters. Only one of these patients had postoperative stone retention which was treated with ERC.…”

Laparoscopic Cholecystectomy Without Intraoperative Cholangiography

“…[6][7][8][9][10][11][12][13] On the other hand, opponents argue that a safe LC can be performed without the routine addition of IOC. [14][15][16][17] The aim of this retrospective study was to evaluate the outcome of LCs performed in our unit since the introduction of the technique, and the impact of our policy not to perform IOC on the incidence of BDI.…”