Advantages of routine intraoperative cholangiography in a teaching hospital

Being one of the most common performed procedures by a general surgeon, laparoscopic cholecystectomy (LC) is carried out daily in most surgical centers worldwide. Performing a routine intraoperative cholangiography (IOC) for visualization of the common bile duct (CBD), detection of CBD stones, and intraoperative bile duct injury (BDI) remains a much-debated topic.

A retrospective observational single-center study was performed at a teaching hospital, AZ Sint-Lucas Hospital Ghent. All adult patients who underwent a laparoscopic cholecystectomy from January 2016 to April 2021 were included and received routine IOC according to a standardized protocol. Operative time, conversion rate, 30-day postoperative complications, readmissions, and length of stay (LOS) were analyzed. Cholangiography anomalies were registered, and results of the adjuvant endoscopic retrograde cholangiopancreatography (ERCP) were reported.

A total of 1878 patients were enrolled in the study. A total of 4.9% complications were registered, mostly Clavien-Dindo grade 1 or 3, with 2 bile duct injuries (BDI) in the whole study population. LOS was 3.1 days on average. There were 0.91% readmissions. Common bile duct stones were detected in 6.5% of the patients during cholangiography, and this led to a same admission ERCP in 75.4%.

Routine IOC during LC can be performed with low complication rates and possibly decreasing LOS and readmission rate. In surgical training, it may enhance understanding of bile duct anatomy, improve technical skills, and contribute to a more standardized and safer laparoscopic cholecystectomy.