Intravenous cholangiography and operative cholangiography: implications for laparoscopic cholecystectomy

There has been a resurgence of interest in the potential role of intravenous cholangiography with the advent of laparoscopic cholecystectomy. A retrospective review of a historical group of 185 patients undergoing cholecystectomy in whom the results of both intravenous cholangiography (IVC) and routine operative cholangiography (OC) were available was carried out. The common bile duct (CBD) was explored in 31 (16.7%) patients and choledocholithiasis confirmed in 25 (81%). IVC had shown calculi in 17 of these 25 patients (sensitivity, 68%) whereas OC demonstrated calculi in 24 (sensitivity 96%). Out of the six negative duct explorations, IVC suggested stones in two patients (specificity 66%) and OC in four patients (specificity 33%). Ultrasound scan had a sensitivity of only 48% for bile duct calculi. The accuracy of IVC was 68% and OC 84%. Intravenous cholangiography has no routine role in the preoperative assessment in patients undergoing elective cholecystectomy. In high-risk patients, alternative imaging techniques should be used.