Intravenous cholangiography in preoperative assessment of patients considered for laparoscopic cholecystectomy

This study examines the role of intravenous cholangiography in the preoperative assessment of the first 100 patients considered for laparoscopic cholecystectomy at this institution. Intravenous cholangiography detected common bile duct (CBD) stones in 10 patients, of whom only five had a dilated CBD (> 8 mm). There were no cases of inadequate visualization of the CBD using IVC and no allergic reactions to the contrast medium. All CBD stones were confirmed by either endoscopic retrograde cholangiopancreatography (ERCP) or exploration of the CBD. There have been no cases of missed CBD stones during a follow-up period of 8 to 18 months. In contrast, ultrasound scanning was only able to detect one CBD stone, and there was a 14% incidence of inadequate visualisation of the CBD. Intravenous cholangiography is a safe, inexpensive, and highly accurate technique for assessing the CBD in patients undergoing laparoscopic cholecystectomy, with false-positive and false-negative rates of 0 in this study. The timing of the investigation permits preoperative clearance of the duct by ERCP and, should this fail, the option of a single procedure of open exploration of the CBD.