[Role of preoperative cholangiography in laparoscopic cholecystectomy]

The attitude regarding either preoperative or intraoperative cholangiography in patients submitted to laparoscopic cholecystectomy (LC) is not standardized. When no usual attempt to choledochal stones removal is planned, a preoperative diagnosis of choledocholithiasis is desirable, in order to carry out a preoperative ERCP. In some cases, however, clinically suspected lithiasis of CBD is not confirmed by ERCP, which carries an established percentage of risk. From this point of view 123 routine i.v. cholangiography were performed in 173 patients submitted to laparoscopic cholecystectomy: there was an overall 5.7% diagnosis of choledocholithiasis (unsuspected 2.4%). All the cases of unsuspected CBD lithiasis had a dilated CBD at ERCP, not pointed out by previous echography. In two clinically suspected cases, particularly because of transient jaundice, i.v. cholangiography was normal and a useless ERCP was avoided. On these grounds we believe that preoperative i.v. cholangiography (in patients eligible for laparoscopic cholecystectomy) has a particularly restricted role to the cases of suspected choledocholithiasis, when it can be correctly carried out (absence of jaundice). Routine i.v. cholangiography does not seem justified, considering the very low percentage of unsuspected choledocholithiasis, particularly if echography carefully excluded a CBD dilation.