Role of Intraoperative Cholangiogram in Major Liver Resection and Complex Bilio-enteric Bypass Surgery

Background Advances in surgery have decreased postoperative morbidities but bile leak is still a major issue. Intraoperative cholangiogram (IOC) is considered better in identifying bile leaks and anatomical delineation making its expanded use in hepato-biliary surgeries. Objective To assess the role of intraoperative cholangiogram in major hepatectomy and complex bilio-enteric bypass surgery. Method A single-centered, descriptive cross-sectional study between March 2022 to February 2023 among conveniently sampled 32 patients undergoing Hepato-biliary surgeries. One ampoule of meglumine diatrizoate was instilled into the biliary tract and intraoperative pictures were taken via C-arm to visualize the biliary tree and preoperative and intra-operative pictures were compared. Result A total of 32 patients were included in the study with a median age of 42 years and a male-female ratio of 1:1.67. During the bilio-enteric anastomosis, no intraoperative anastomotic leaks were detected. Two patients experienced postoperative bile leakage that was managed conservatively and eight cases had intraoperative bile leakage which was addressed during surgery. The average duration of hospital stay was 5 days. Conclusion An intraoperative cholangiogram is useful to delineate the biliary tract anatomy, reassure anastomosis, and identify bile leaks in difficult bilio-enteric anastomosis and from liver resection margins intraoperatively.