[Can one dispense with preoperative cholangiography in connection with laparoscopic cholecystectomy?]

Since the introduction of laparoscopic cholecystectomy as method of choice for the treatment of gallstone disease, many authors have proposed a preoperative intravenous cholangiogram as an alternative to routine intraoperative cholangiography. To assess the value of intravenous cholangiography we performed a prospective randomized study with 100 patients undergoing cholecystectomy for gallstone disease. Patients with predefined criteria indicating possible choledocholithiasis were excluded. In none of the 50 performed i.v.-cholangiograms was evidence of a stone in the common bile duct or an anatomic variation of the biliary tract found. There was no significant difference in regard to intra- and postoperative complications between the group with preoperative cholangiography and the group without intravenous cholangiogram. We conclude that there is no significant advantage in performing routine preoperative intravenous cholangiography, and recommend the selective use of intraoperative cholangiography.