Cost-effective laparoscopic cholangiography

Cholangiography during laparoscopic cholecystectomy is an invaluable tool for detecting occult bile duct calculi and identifying biliary tract anatomy. Attaining proficiency in cannulation of the cystic duct is an important goal for those interested in laparoscopic transcystic common duct manipulation. A variety of disposable equipment is available for this purpose, but most systems are rather costly for the patient. This report describes our experience with a technique for cholangiography that is both highly successful and inexpensive. It consists of a reusable 8" stainless steel blunt-tipped needle and trocar introducer through which a 4-French, disposable, end-hole catheter is placed into the duct and secured with a single clip. A 0.25 hydrophilic guidewire is placed through this catheter to facilitate proper catheter placement when cystic duct cannulation is difficult. Blunt-tip reusable nylon rods are placed in each trocar site to provide unobstructed visualization of the biliary tract during the fluoroscopy or filming procedures. Thirty-seven consecutive patients had successful cholangiograms during laparoscopic cholecystectomy using this technique, including the use of the guidewire in five patients, without complications. The catheter was advanced into the common duct and secured with clips to provide postoperative duct drainage in two patients with unsuspected common duct stones and very small cystic ducts until successful postoperative endoscopic retrograde cholangiopancreatography (ERCP) stone extractions were done. Three additional patients had occult common duct stones discovered during operative cholangiography. All patients were successfully treated postoperatively with ERCP sphincterotomy and stone extraction without complications. Our technique provides successful, cost-effective operative cholangiography, including cases when cystic duct cannulation is difficult.(ABSTRACT TRUNCATED AT 250 WORDS)