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Intravenous cholangiography is superfluous prior to laparoscopic cholecystectomy
1Dept. Chirurgie, Universitätsspital Zürich.
Objective:
Intravenous cholangiography (IVC) re-introduced into the preoperative diagnostic work-up of cholecystectomy after the change to the laparoscopic technique, was suggested to detect anatomical anomalies and bile duct stones. The value of IVC in this context was to be evaluated by this study.
Design:
Prospectively controlled study. IVC findings were controlled by intraoperative imaging techniques such as laparoscopic sonography and intraoperative cholangiography.
Setting:
Surgical unit of a university hospital.
Subjects:
One hundred patients underwent laparoscopic cholecystectomy between January 1992 and January 1993. Eighty-five of these patients had both IVC and intraoperative cholangiography (IOC). There were nine technical failures for IVC and five for IOC.
Main Outcome Measures:
Anatomical variations and previously unsuspected common duct stones.
Results:
Anatomical variations of the biliary tree and the hepatic vessels were detected by IVC in only three cases while IOC demonstrated 31 biliary and vascular anomalies in 28 patients. IVC demonstrated bile duct stones in one and IOC in two cases.
Conclusions:
We conclude that IVC is of little help in the diagnosis of anatomical variations of the biliary tree and should be omitted from the preoperative diagnostic work-up of laparoscopic cholecystectomy.