Intravenous cholangiography before 1000 consecutive laparoscopic cholecystectomies

The advent of laparoscopic cholecystectomy has resulted in an increase in common bile duct (CBD) injuries. Routine intraoperative cholangiography has been advocated to prevent these injuries. This study describes an alternative management strategy applied to a consecutive series of 1000 patients having laparoscopic cholecystectomy.

In patients with no history of contrast allergy and no suspicion of CBD stones, preoperative intravenous cholangiography (i.v.c.) was performed routinely. Patients with suspected or detected CBD stones were referred for endoscopic retrograde cholangiography. This strategy was supplemented by selective intraoperative cholangiography.

Overall 782 of the 1000 patients had successful preoperative i.v.c., allowing detection of 30 CBD stones and providing useful information about anatomical variation in CBD anatomy. Patients with inconclusive i.v.c. studies, or those with a history of contrast allergy, had intraoperative cholangiography, which demonstrated a further 19 CBD stones. There were no contrast reactions and no damage to the biliary system which might have been obviated by intraoperative cholangiography. In the 724 patients who did not require complimentary intraoperative cholangiography, there has been no clinical evidence of missed CBD stones.

Routine preoperative i.v.c., with reservation of intraoperative cholangiography for indeterminate i.v.c. examinations or the need for anatomical clarification, is a safe strategy for laparoscopic cholecystectomy.