The case for routine operative cholangiography during laparoscopic cholecystectomy.

The debate over routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy continues because of a paucity of objective data to support or refute the case for either approach. The introduction of fluoroscopic techniques during the performance of cholangiography is an important step forward because it decreases the operative time for the technique and because real-time visualization may also diminish the number of false-positive and false-negative results. Routine cholangiography improves the surgeon's ability to delineate the biliary anatomy when the need arises and undoubtedly facilitates the development of skills useful for the laparoscopic management of common bile duct calculi. Normal results on intraoperative cholangiography are also reassuring to the surgeon, given the current visual and tactile limitations of laparoscopy. As a result of these considerations as well as our procurement of a digital fluoroscopic system and the need to train surgical residents in cholangiographic techniques, we have adopted a policy of routine fluoroscopic intraoperative cholangiography on all patients undergoing laparoscopic cholecystectomy.