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Published on: January 31, 2025
Systematic intraoperative cholangiography during elective laparoscopic cholecystectomy: Is it a justifiable practice?
Francesco Esposito1, Iolanda Scoleri1, Rafika Cattan1
1Visceral and Digestive Surgery Unit, Grand Hôpital de l'Est Francilien, Meaux, France.
Backgrounds/Aims:
Routine execution of intraoperative cholangiography (IOC) in laparoscopic cholecystectomy (LC) is considered a good practice to help early identification of biliary duct injuries (BDIs) or common bile duct (CBD) stones. This study aimed to determine the impact of IOC during LC.
Methods:
This is a retrospective, monocentric study, including patients with a LC performed from January 2020 to December 2021.
Results:
Of 303 patients, 215 (71.0%) were in the IOC group and 88 (29.0%) in the no-IOC group. IOC was incomplete or unclear in 10.7% of patients, with a failure rate of 14.7%. Operating time was 15 minutes longer in the IOC group (p = 0.01), and postoperative complications were higher (5.1% vs. 0.0%, p = 0.03). There were three BDIs (0.99%), all included in the IOC group; only one was diagnosed intraoperatively, and the other two were identified during the postoperative course. Regarding identifying CBD stones, IOC showed a sensitivity of 77%, a specificity of 98%, an accuracy of 97.2%, a positive predictive value of 63% and a negative predictive value of 99%.
Conclusions:
Systematic IOC has shown no specific benefits and prolonged operative duration. IOC should be performed on selected patients or in situations of uncertainty on the anatomy.
