Intraoperative cholangiography in laparoscopic cholecystectomy: a review of 734 consecutive cases

Intraoperative cholangiography was first introduced by Mirizzi in 1931. He recommended its routine use. The debate over the appropriate role of intraoperative cholangiography was renewed by the widespread acceptance of laparoscopic cholecystectomy in 1988. We reviewed our experience to determine the most appropriate use of intraoperative cholangiography. Seven hundred thirty-four consecutive cases of laparoscopic cholecystectomy performed between January 1, 1991 and December 31, 1993 were reviewed. The Routine Group of 276 cases, performed by 3 surgeons practicing routine cholangiography, was compared to the Selective Group of 458 cases, performed by 16 surgeons practicing selective cholangiography. The groups were similar in terms of age, sex, and extent of disease. No statistically significant difference was found between the two groups in number of successful cholangiograms, filling defects, misinterpretation of cholangiograms, complications, or length of hospitalization. One common duct injury occurred in the Routine Group. The rate of conversion to open cholecystectomy was higher in the Routine Group. A cholangiogram added 14 minutes to the average duration of surgery and $737 to the average cost. We found that routine cholangiography did not increase common duct stone detection, did not decrease common duct injury, and did not increase technical skill, but it did increase cost. We feel that intraoperative cholangiography should be used selectively where choledocholithiasis is suspected or biliary anatomy is unclear.