Results of a change to routine fluorocholangiography during laparoscopic cholecystectomy

Early in our experience with laparoscopic cholecystectomy (LC), intraoperative cholangiography (IOC) was performed selectively with static imaging techniques. We subsequently changed to routine digital fluorocholangiography (FIOC) and evaluated the results of this strategy.

In a consecutive series of 356 LCs, 11 patients (3%) were converted to open cholecystectomy. In the remaining 345 patients FIOC was attempted in 336 patients (97%) and was successfully completed in 328 patients (95%). Results of IOC and outcomes were compared prospectively in patients without indications for IOC (group I, n = 185) with those with criteria for selective IOC (group 2, n = 160) and retrospectively with patients without indications for IOC undergoing static IOC (group 3, n = 56).

Time to perform FIOC was less than for static IOC (14 +/- 1 versus 24 +/- 1 minutes, p < 0.001). Aberrant ductal anatomy was appreciated by using FIOC in 11% but affected operative management in only 3% of patients. Choledocholithiasis was detected in 23 patients (7%) undergoing FIOC; only two of these patients with stones were in Group 1. Duct stones discovered by IOC were cleared laparoscopically in 89% of those attempted (73% of all patients). Neither morbidity nor duct injury caused by FIOC was noted.

FIOC is much more rapid to perform than static IOC. Digital fluoroscopy is accurate and safe and permits rapid evaluation and management of bile duct stones. Selective use of FIOC efficiently assesses the common duct in the era of LC.