Situations That Preclude Routine Intraoperative Cholangiography

Intraoperative cholangiogram (IOC) is a useful tool for surgeons to assess anatomy of the biliary tree and diagnose biliary pathology. Many surgeons utilize cholangiography in most cases in hopes of preventing ductal injuries and are deemed routine cholangiographers. There is little data on the success rate and reasons why IOC is not performed. The purpose of this study was to evaluate the use of routine cholangiography and to determine reasons why cholangiography was not performed. 693 cholecystectomies were analyzed. Intraoperative cholangiogram was attempted in 553 (79.8%) of these cases. The success rate of performing cholangiograms in those attempted was 93.3%. Intraoperative cholangiogram was not attempted in 140 patients (20.2%) for various reasons. Although many surgeons consider themselves routine cholangiographers, there are times when IOC is not feasible. Knowledge of these reasons may help clarify indications for IOC. For most cases, routine cholangiography appears to be feasible.