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Routine cholangiography reduces sequelae of common bile duct injuries
B J Carroll1, R L Friedman, M A Liberman
1Division of Surgery, Cedars-Sinai Medical Center, 8635 W. 3rd Street, Suite 795W, Los Angeles, CA 90048, USA.
Background:
An effort was made to determine whether a policy of routine cholangiography affects the incidence, morbidity, and cost of bile duct injuries.
Methods:
A retrospective review of consecutive 3,242 laparoscopic cholecystectomies was performed. Most patients had routine intraoperative cholangiography.
Results:
There were 12 bile duct injuries (0.37%). All injuries were Bismuth levels 1 and 2. Eleven of 12 injuries were recognized intraoperatively. Ten were repaired primarily and one required hepaticojejunostomy. All repairs were successful. Average hospital charges were $26,669. One of 12 patients had delayed recognition of a bile duct injury and underwent primary repair over a T-tube on postoperative day 7. Hospital charges were $43,957.
Conclusion:
Routine cholangiography did not appear to decrease the absolute incidence of bile duct injuries compared to previously published reports. Injury severity, morbidity, late sequelae, and costs were reduced by a policy of routine cholangiography.