Systematic intraoperative cholangiography during elective laparoscopic cholecystectomy: Is it a justifiable practice?

Area of Science:

• Gastroenterology
• Surgical Innovation
• Biliary Surgery

Background:

• Intraoperative cholangiography (IOC) is often standard practice during laparoscopic cholecystectomy (LC).
• Its routine use aims to detect biliary duct injuries (BDIs) and common bile duct (CBD) stones.
• The actual impact of routine IOC on patient outcomes requires evaluation.

Purpose of the Study:

• To determine the impact of routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC).
• To assess the effectiveness of IOC in identifying BDI and CBD stones.
• To evaluate the influence of IOC on operative time and postoperative complications.

Main Methods:

• Retrospective, monocentric study.
• Inclusion of patients who underwent LC between January 2020 and December 2021.
• Comparison of outcomes between patients who had IOC and those who did not.

Main Results:

• IOC was performed in 71% of 303 patients, with a 14.7% failure rate.
• IOC group had a 15-minute longer operative time (p=0.01) and higher postoperative complications (5.1% vs. 0.0%, p=0.03).
• Three BDIs occurred, all in the IOC group, with only one diagnosed intraoperatively. IOC sensitivity for CBD stones was 77%, specificity 98%.

Conclusions:

• Routine IOC during LC offers no clear advantages and extends operative duration.
• IOC should be reserved for selected patients or ambiguous anatomical situations.
• Selective IOC may help optimize surgical workflow and patient safety.