Clinical implication of preoperative oral cholecystogram for laparoscopic cholecystectomy

The aim of this study was to retrospectively assess the usefulness of the preoperative oral cholecystogram (OCG) as an index to the feasibility of laparoscopic cholecystectomy (LC) and the operative pathologic findings. Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder (GB) disease. However, no definite diagnostic modality that can predict the feasibility of LC and severity of pathologic anatomy has been proposed.

Retrospective data were collected on 240 consecutive patients undergoing LC at St. Vincent Hospital, Catholic University Medical College, from October 1991 until December 1993. Radiologic interpretations of OCG were standardized according to the method of Koehler and Kyaw--from grade 0 to 4. And the operative findings--pericholecystic adhesion, color of GB, and thickness of the GB wall--were evaluated simultaneously.

The analysis showed that preoperative OCG can predict intraoperative GB perforation (p = 0.022), intraoperative controllable bleeding (p = 0.034), and operating time (p = 0.0001) according to the grade of visualization of GB. Grade 2- or -better visualized groups had more patients who had blue-colored GB (p = 0.000) and who had thin GB wall (p = 0.000).

Preoperative oral cholecystogram may be an accurate index of the feasibility of laparoscopic cholecystectomy--represented by operating time and important intraoperative minor complications related to the operative pathological findings.