Routine preoperative infusion cholangiography at elective cholecystectomy: a prospective study in 694 patients

Area of Science:

• Gastroenterology
• Surgical Imaging
• Biliary System Diagnostics

Background:

• The diagnostic value of preoperative infusion cholangiography (PIC) prior to elective cholecystectomy remains debated.
• Biliary calculus disease necessitates careful preoperative assessment to guide surgical strategy.

Purpose of the Study:

• To evaluate the role and necessity of routine preoperative infusion cholangiography (PIC) in patients undergoing elective cholecystectomy for biliary calculus disease.
• To assess the diagnostic accuracy and impact of PIC on surgical decision-making and patient safety.

Main Methods:

• A retrospective analysis of 694 patients undergoing elective cholecystectomy between 1985 and 1991.
• Routine preoperative infusion cholangiography (PIC) was performed 1-4 days before surgery.
• Comparison of PIC findings with peroperative cholangiography (POC) and intraoperative findings.

Main Results:

• Satisfactory biliary opacification was achieved in 90.1% of patients with a 0.9% rate of mild to moderate adverse reactions.
• PIC identified common bile duct stones in 8 of 26 suspected cases and bile duct anomalies in 35 patients (0.9% incidence).
• Information from PIC was not crucial for safe cholecystectomy; a single bile duct lesion (0.1%) was attributed to severe pericholecystitis.

Conclusions:

• Routine preoperative infusion cholangiography (PIC) is not recommended for all patients undergoing elective cholecystectomy.
• PIC can serve as an alternative to selective endoscopic retrograde cholangiography or peroperative cholangiography (POC).
• Selective use of PIC, supported by POC in approximately 20% of cases, is a viable approach for specific indications.