Intraoperative systematic cholangiography in celiopscopic cholecystectomy

Objective: Laparoscopic cholecystectomy has become the therapeutic gold standard in uncomplicated cases of cholelithiasis. This study evaluated the feasibility and the results of intra-operative cholangiography during laparoscopic cholecystectomy.

Methods: Intra-operative cholangiography was attempted in 126 consecutive patients undergoing laparoscopic cholecystectomy. Common bile duct stones were detected according to the following criteria: a) clinically (history of jaundice or pancreatitis); b) biologically (aminotransferase > 2 N, alkaline phosphatase > 2 N, total bilirubin > 20 mumol/L); c) ultrasonographically (diameter of the common bile duct > 12 mm, presence of gallbladder stones < 10 mm); d) calculation of the multifactorial score of Huguier.

Results: An intraoperative cholangiography was performed in 116 patients (92%), for a mean duration of 16 minutes (range: 9-25 min). Two anomalies of the biliary tree were detected. Ten common bile duct stones were detected (8.6% with 50% success of laparoscopic extraction). One false positive case had justified a surgical exploration of the common bile duct. The sensitivity of preoperative criteria was 80%. No morbidity or postoperative biliary complications were related to the intraoperative cholangiography.

Conclusions: Routine intraoperative cholangiography should be systematically performed during laparoscopic cholecystectomy, providing anatomical information of the biliary tree and detecting, in 1.7% of cases, unsuspected common bile duct stones which could be treated during the same operative procedure.