Selective operative cholangiography in laparoscopic cholecystectomy

At the Kaiser Foundation Hospital in Los Angeles, 1344 patients underwent laparoscopic cholecystectomy from December 1990 through April 1994. Intraoperative cholangiography was done selectively at the discretion of the surgeon in only 98 (7%) of patients. The most common indications were a history of jaundice, abnormalities of liver function tests, or gallstone pancreatitis. Patients with increasing or persistent liver function test abnormalities and/or ultrasound identification of stones in a dilated common bile duct underwent either preoperative endoscopic retrograde cannulation of the common duct (ERCP) and endoscopic sphincterotomy or open common bile duct exploration, according to their wishes. Laparoscopic common bile duct exploration was not performed. Postoperative ERCP was performed in seven patients with suspected retained stones, but was normal in six. The single patient with a retained stone was successfully treated with endoscopic sphincterotomy. No patient had an unsuccessful ERCP or endoscopic sphincterotomy, and none required reoperation for a retained stone. There were no major common duct injuries. Six patients with small stones in nondilated ducts on intraoperative cholangiography have been followed without intervention and remain clinically well. Routine intraoperative cholangiography is not essential to prevent common bile duct injury or retained stones in laparoscopic cholecystectomy patients.