Safe laparoscopic cholecystectomy without intraoperative cholangiography

The role of intraoperative cholangiography during laparoscopic cholecystectomy is controversial. Between July 1990 and June 1991, 82 of 84 consecutive patients (mean age, 46 +/- 14 years) with symptomatic cholelithiasis successfully underwent laparoscopic cholecystectomy with only one intraoperative cholangiogram. Fourteen patients underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis of which two demonstrated common duct stones and underwent sphincterotomy. Complications of laparoscopic cholecystectomy included one each of bilioma, umbilical wound infection, epigastric trocar site hernia, and flank seroma. No major bile duct or vascular injury occurred. Follow-up data was available on all patients for a mean of 7.4 months (range, 3-13 months). Three patients developed symptoms suggestive of biliary tract disease at 0.25, 4, and 8 months postoperatively. Symptoms spontaneously resolved in all three; all underwent ERCP, of which two were normal and one unsuccessful. We have concluded that (a) a meticulous operative dissection resulted in no major bile duct or vascular injury; (b) patients with unsuspected choledocholithiasis preoperatively rarely developed postoperative symptoms; and (c) the practice of laparoscopic cholecystectomy can be conducted safely without intraoperative cholangiography.