[Intraoperative laparoscopic cholangiography -- when is it useful?]

Area of Science:

• Surgical Gastroenterology
• Minimally Invasive Surgery
• Biliary Tract Surgery

Background:

• Laparoscopic cholecystectomy (LC) has led to reduced intraoperative cholangiography (IOC) use.
• The necessity and optimal application of IOC during LC remain debated, particularly concerning common bile duct (CBD) stone management.

Purpose of the Study:

• To evaluate the indications and benefits of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC).
• To determine the role of IOC in managing common bile duct (CBD) stones and preventing CBD injuries.

Main Methods:

• Review of current practices and recommendations for IOC during LC.
• Analysis of IOC's utility in single-stage versus two-stage CBD stone treatment strategies.
• Assessment of IOC's role in preventing CBD injuries.

Main Results:

• Routine IOC is necessary for single-stage laparoscopic CBD stone extraction.
• Selective IOC can be foregone in two-stage management (endoscopic stone removal followed by LC).
• Selective IOC reduces unnecessary preoperative investigations from 40-60% to 20% with similar success rates (95%).
• Routine IOC is recommended for institutions with CBD injury rates >0.4% or for surgeons in training.
• Selective IOC is advised in cases of difficult anatomy during LC.

Conclusions:

• IOC's role in LC depends on the chosen CBD stone management strategy.
• Selective IOC offers benefits in reducing preoperative workup, but routine IOC provides a safety net for specific scenarios.
• Institutions and surgeons should tailor IOC practice based on their specific needs and performance metrics.