Routine or selected intraoperative cholangiography during laparoscopic cholecystectomy?

Intraoperative cholangiography can be helpful in cases in which the anatomy is obscured, unsuspected stones are discovered, or anatomic anomalies of surgical importance are found. There is a difference between open and closed laparoscopic cholecystectomy. It is more difficult to locate the common bile duct during laparoscopic cholecystectomy. During this procedure, the anatomy is distorted due to the extreme traction at the infundibulum. With a short cystic duct, the common bile duct can become "tented" and simulate the appearance of the cystic duct. Ductal injuries may be avoided by knowing where the clips should be placed in relation to the ductal system and by obtaining information about the intact display of the distal and proximal ductal system. The image can be observed immediately by using a modern fluoroscopic system, and permanent documentation can be obtained. We attempted intraoperative cholangiography in 415 cases and were successful in 90%. We strongly recommend the routine use of intraoperative cholangiography.