BACKGROUND: The role of routine intraoperative cholangiography is controversial. The aim of this study was to assess the impact of routine intraoperative cholangiography on the incidence of common bile duct injuries, and to evaluate the operative outcome of laparoscopic cholecystectomy carried out in a major teaching hospital and review the literature. METHODS: Prospectively collected data on 3,145 laparoscopic cholecystectomies performed mainly by surgical trainees in the period 1990 to 2002 using routine intraoperative cholangiography with fluoroscopy were reviewed. RESULTS: The mean age of the study sample (65.6% male, 34.4% female) was 54 years, and 16.9% of the patients had clinical acute cholecystitis. The conversion rate to open cholecystectomy was 4.3%. Intraoperative cholangiography was attempted for 90.7% of the patients with a 95.9% success rate. Five patients (0.16%) had common bile duct injuries. Four injuries had occurred in the first 5 years. One injury (0.06%) had occurred after 1995. This injury was identified intraoperatively and repaired laparoscopically. Routine intraoperative cholangiography prevented one definite common bile duct transection. CONCLUSIONS: In this series using routine intraoperative cholangiography, there was a low rate and severity of common bile duct injuries, with a high intraoperative recognition rate. There was no bile duct transection or major injury requiring common bile duct reconstruction. Although intraoperative cholangiography helped in the immediate identification of injuries and the institution of appropriate therapy, injury was not completely prevented.
BACKGROUND: The role of routine intraoperative cholangiography is controversial. The aim of this study was to assess the impact of routine intraoperative cholangiography on the incidence of common bile duct injuries, and to evaluate the operative outcome of laparoscopic cholecystectomy carried out in a major teaching hospital and review the literature. METHODS: Prospectively collected data on 3,145 laparoscopic cholecystectomies performed mainly by surgical trainees in the period 1990 to 2002 using routine intraoperative cholangiography with fluoroscopy were reviewed. RESULTS: The mean age of the study sample (65.6% male, 34.4% female) was 54 years, and 16.9% of the patients had clinical acute cholecystitis. The conversion rate to open cholecystectomy was 4.3%. Intraoperative cholangiography was attempted for 90.7% of the patients with a 95.9% success rate. Five patients (0.16%) had common bile duct injuries. Four injuries had occurred in the first 5 years. One injury (0.06%) had occurred after 1995. This injury was identified intraoperatively and repaired laparoscopically. Routine intraoperative cholangiography prevented one definite common bile duct transection. CONCLUSIONS: In this series using routine intraoperative cholangiography, there was a low rate and severity of common bile duct injuries, with a high intraoperative recognition rate. There was no bile duct transection or major injury requiring common bile duct reconstruction. Although intraoperative cholangiography helped in the immediate identification of injuries and the institution of appropriate therapy, injury was not completely prevented.
Authors: Y D Podnos; D V Gelfand; T S Dulkanchainun; S E Wilson; S Cao; P Ji; J A Ortiz; D K Imagawa Journal: Am J Surg Date: 2001-12 Impact factor: 2.565
Authors: D R Fletcher; M S Hobbs; P Tan; L J Valinsky; R L Hockey; T J Pikora; M W Knuiman; H J Sheiner; A Edis Journal: Ann Surg Date: 1999-04 Impact factor: 12.969
Authors: S J Savader; K D Lillemoe; C A Prescott; A B Winick; A C Venbrux; G B Lund; S E Mitchell; J L Cameron; F A Osterman Journal: Ann Surg Date: 1997-03 Impact factor: 12.969
Authors: Junji Machi; James O Johnson; Daniel J Deziel; Nathaniel J Soper; Eren Berber; Allan Siperstein; Masaki Hata; Anand Patel; Kirpal Singh; Maurice E Arregui Journal: Surg Endosc Date: 2008-06-05 Impact factor: 4.584
Authors: Sylvester N Osayi; Mark R Wendling; Joseph M Drosdeck; Umer I Chaudhry; Kyle A Perry; Sabrena F Noria; Dean J Mikami; Bradley J Needleman; Peter Muscarella; Mahmoud Abdel-Rasoul; David B Renton; W Scott Melvin; Jeffrey W Hazey; Vimal K Narula Journal: Surg Endosc Date: 2014-07-02 Impact factor: 4.584