Role of intraoperative cholangiography during endoscopic cholecystectomy

Six hundred sixty-nine German hospitals participated in a survey on the use of intraoperative cholangiography (IOC) in its relationship to common bile duct injuries. Of these, 174 surgical departments are presently practicing IOC, 30 routinely. Only 16 injuries to the bile duct occurred in the 6,328 patients who underwent surgery in those 30 units. Approximately 80% of these injuries were discovered during surgery because of IOC and were treated immediately. A significant difference was found between these rates and those reported by units that performed IOC selectively. Only 58% of bile duct injuries were discovered at the time of surgery in units performing selective cholangiography. In addition, it appears that IOC helps to avoid bile duct injuries; the 30 units that performed routine IOC were defined as "learners," as they had performed fewer LCs, and yet they had a significant lower bile duct injury rate than "experienced" centers that did not perform IOC routinely.