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Related Experiment Videos

Selective cholangiography in laparoscopic cholecystectomy

P A Grace1, A Qureshi, P Burke

  • 1Department of Surgery, Royal College of Surgeons, Beaumont Hospital, Dublin, Ireland.

The British Journal of Surgery
|February 1, 1993
PubMed
Summary

Routine preoperative cholangiography is unnecessary for laparoscopic cholecystectomy. Most patients without this procedure, even with asymptomatic common bile duct stones, do not develop complications.

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Area of Science:

  • Gastroenterology and Hepatobiliary Surgery
  • Minimally Invasive Surgical Procedures

Background:

  • Laparoscopic cholecystectomy is the standard treatment for gallbladder disease.
  • Asymptomatic common bile duct stones affect about 6% of patients.
  • The necessity of routine peroperative cholangiography during this procedure is debated.

Purpose of the Study:

  • To evaluate the necessity of routine preoperative or peroperative cholangiography during laparoscopic cholecystectomy.
  • To assess the incidence of common bile duct stones and injuries in patients undergoing laparoscopic cholecystectomy without routine cholangiography.

Main Methods:

  • A prospective study of 300 consecutive laparoscopic cholecystectomies over 21 months.
  • Cholangiography was not routinely performed; selective use was based on clinical indications.

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  • Comparison of outcomes between patients who did and did not undergo cholangiography, including follow-up for symptomatic duct stones.

    • Main Results:

    • Of 229 patients not undergoing cholangiography, two (0.8%) sustained common bile duct injuries, identified and managed operatively.
    • No common bile duct pathology was found in the five patients who underwent peroperative cholangiography.
    • Endoscopic retrograde cholangiopancreatography identified common bile duct stones in 26% of patients preoperatively and 18% postoperatively.

    Conclusions:

    • Routine preoperative or peroperative cholangiography is not necessary for laparoscopic cholecystectomy.
    • Selective cholangiography may be indicated for patients with suspected common bile duct stones or unclear biliary anatomy.
    • The risk of undetected common bile duct stones is low in patients not undergoing routine cholangiography.