Role of routine intraoperative cholangiography during laparoscopic cholecystectomy

Routine intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC), a radiologic contrast-based examination of the bile duct, can represent a systemic approach to avoiding common bile duct injury

This was a prospective study, conducted in the Department of General Surgery, Government Medical College/Rajindra Hospital, Patiala. 100 consecutive patients suffering from symptomatic gall stones undergoing LC were included in the study. The intraoperative cholangiograms were obtained. Two films were taken in addition to a preoperative scout film. The films were immediately interpreted. The catheter was taken out and the gall bladder was removed as usual, and ports were taken out after putting drain in the abdominal cavity.

A total of 100 patients were included in the study. Average age was 43.7 years and majority of them were females (80%). 60% of patients presented with pain abdomen while 40% presented with dyspepsia along with pain abdomen. Out of the 100, successful cannulation of the cystic duct was achieved in 92 patients. There was significant additional operating time ranging from 17 to 42 min with mean time of 24.82 min. There was no intraoperative complication. Total additional cost of IOC was in range of Rs. 2200-2500. No patient re-presented to us with biliary symptoms within 18 months of surgery.

In our study, we conclude that routine IOC was successful and safe, yields information that was not useful to alter operative management. The operating time was significantly longer but there was no significant difference in the hospital stay. Routine IOC decreases the readmission rate with post cholecystectomy syndrome, which occurs in 10-40% of the post cholecystectomy patients.