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Routine Cholangiography Is Not Warranted During Laparoscopic Cholecystectomy

Routine Cholangiography Is Not Warranted During Laparoscopic Cholecystectomy Abstract • The role of intraoperative cholangiography during laparoscopic cholecystectomy was prospectively evaluated in 514 patients undergoing laparoscopic cholecystectomy. Before surgery, all patients were assigned to one of three groups depending on the likelihood of their having common bile duct stones. Stratification was based on objective historical, laboratory, or radiologic criteria. In 453 patients deemed unlikely to have stones, laparoscopic cholecystectomy was performed without cholangiography. Of these patients, four had retained stones (0.9%). In 25 patients likely to have stones, preoperative endoscopic retrograde cholangiopancreatography identified stones in six patients (24%). In 36 patients whose likelihood of having stones was deemed indeterminate, intraoperative cholangiography was performed at laparoscopic cholecystectomy. A common bile duct stone was identified in one patient (2.8%). One common bile duct injury occurred in the group deemed unlikely to have stones, and this injury would not have been prevented by intraoperative cholangiography. We conclude that preoperative assessment will identify common bile duct stones and that routine cholangiography is not warranted. Meticulous dissection of the cystic duct at its origin at the infundibulum will prevent common bile duct injury. (Arch Surg. 1993;128:551-555) References 1. Mirizzi PL. Operative cholangiography . Surg Gynecol Obstet . 1932; 65:702-710. 2. Reddick EJ, Olsen DO. Laparoscopic laser cholecystectomy: a comparison with minilap cholecystectomy . Surg Endosc . 1989;3:131-133.Crossref 3. Hunter JG. Avoidance of bile duct injury during laparoscopic cholecystectomy . Am J Surg . 1991;162:71-76.Crossref 4. Gerber A, Apt MK. The case against routine operative cholangiography . Am J Surg . 1982;143:734-736.Crossref 5. Gregg RO. The case for selective cholangiography . Am J Surg . 1988;155:540-544.Crossref 6. Bartlett MK, Quinby WC. Mortality and complications of cholecystectomy and choledochostomy for chronic cholecystitis . N Engl J Med . 1956;254:154-156.Crossref 7. Glenn F, McSherry CK. Calculous biliary tract disease . Curr Probl Surg . 1975;12:26-33.Crossref 8. Flowers JL, Zucker KA, Graham SM, Scovill WA, Imbembo AL, Bailey RW. Laparoscopic cholangiography . Ann Surg . 1992;215:209-216.Crossref 9. Skillings JC, Williams JS, Hinshaw JR. Cost-effectiveness of operative cholangiography . Am J Surg . 1979;137:26-31.Crossref 10. Bogokowsky H, Slutzki S, Zaidenstein L, Halpern Z, Negri M, Abramsohn R. Selective operative cholangiography . Surg Gynecol Obstet . 1987; 164:124-126. 11. Gerber A. A requiem for the routine operative cholangiogram . Surg Gynecol Obstet . 1986;163:363-364. 12. Pace BW, Cosgrove J, Breuer B, Margolis IB. Intraoperative cholangiography revisited . Arch Surg . 1992;127:448-450.Crossref 13. The Southern Surgical Club. A prospective analysis of 1518 laparoscopic cholecystectomies . N Engl J Med . 1991;324:1073-1078.Crossref 14. Soper NJ, Flye MW, Brunt LM, Stockman PT, Sicard GA, Picus DD. Dark lining to the silver cloud: biliary complications of laparoscopic cholecystectomy . Gastroenterology . 1992;102( (suppl 4) ):29. 15. Berci G, Sackier JM, Paz-Partlow M. Routine or selected intraoperative cholangiography during laparoscopic cholecystectomy? Am J Surg . 1991;161:355-360.Crossref 16. Lillemoe KD, Yeo CJ, Talamini MA, Wang BH, Pitt HA, Gadacz TR. Selective cholangiography: current role in laparoscopic cholecystectomy . Ann Surg . 1992;215:669-676.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Routine Cholangiography Is Not Warranted During Laparoscopic Cholecystectomy

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References (19)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1993.01420170085012
Publisher site
See Article on Publisher Site

Abstract

Abstract • The role of intraoperative cholangiography during laparoscopic cholecystectomy was prospectively evaluated in 514 patients undergoing laparoscopic cholecystectomy. Before surgery, all patients were assigned to one of three groups depending on the likelihood of their having common bile duct stones. Stratification was based on objective historical, laboratory, or radiologic criteria. In 453 patients deemed unlikely to have stones, laparoscopic cholecystectomy was performed without cholangiography. Of these patients, four had retained stones (0.9%). In 25 patients likely to have stones, preoperative endoscopic retrograde cholangiopancreatography identified stones in six patients (24%). In 36 patients whose likelihood of having stones was deemed indeterminate, intraoperative cholangiography was performed at laparoscopic cholecystectomy. A common bile duct stone was identified in one patient (2.8%). One common bile duct injury occurred in the group deemed unlikely to have stones, and this injury would not have been prevented by intraoperative cholangiography. We conclude that preoperative assessment will identify common bile duct stones and that routine cholangiography is not warranted. Meticulous dissection of the cystic duct at its origin at the infundibulum will prevent common bile duct injury. (Arch Surg. 1993;128:551-555) References 1. Mirizzi PL. Operative cholangiography . Surg Gynecol Obstet . 1932; 65:702-710. 2. Reddick EJ, Olsen DO. Laparoscopic laser cholecystectomy: a comparison with minilap cholecystectomy . Surg Endosc . 1989;3:131-133.Crossref 3. Hunter JG. Avoidance of bile duct injury during laparoscopic cholecystectomy . Am J Surg . 1991;162:71-76.Crossref 4. Gerber A, Apt MK. The case against routine operative cholangiography . Am J Surg . 1982;143:734-736.Crossref 5. Gregg RO. The case for selective cholangiography . Am J Surg . 1988;155:540-544.Crossref 6. Bartlett MK, Quinby WC. Mortality and complications of cholecystectomy and choledochostomy for chronic cholecystitis . N Engl J Med . 1956;254:154-156.Crossref 7. Glenn F, McSherry CK. Calculous biliary tract disease . Curr Probl Surg . 1975;12:26-33.Crossref 8. Flowers JL, Zucker KA, Graham SM, Scovill WA, Imbembo AL, Bailey RW. Laparoscopic cholangiography . Ann Surg . 1992;215:209-216.Crossref 9. Skillings JC, Williams JS, Hinshaw JR. Cost-effectiveness of operative cholangiography . Am J Surg . 1979;137:26-31.Crossref 10. Bogokowsky H, Slutzki S, Zaidenstein L, Halpern Z, Negri M, Abramsohn R. Selective operative cholangiography . Surg Gynecol Obstet . 1987; 164:124-126. 11. Gerber A. A requiem for the routine operative cholangiogram . Surg Gynecol Obstet . 1986;163:363-364. 12. Pace BW, Cosgrove J, Breuer B, Margolis IB. Intraoperative cholangiography revisited . Arch Surg . 1992;127:448-450.Crossref 13. The Southern Surgical Club. A prospective analysis of 1518 laparoscopic cholecystectomies . N Engl J Med . 1991;324:1073-1078.Crossref 14. Soper NJ, Flye MW, Brunt LM, Stockman PT, Sicard GA, Picus DD. Dark lining to the silver cloud: biliary complications of laparoscopic cholecystectomy . Gastroenterology . 1992;102( (suppl 4) ):29. 15. Berci G, Sackier JM, Paz-Partlow M. Routine or selected intraoperative cholangiography during laparoscopic cholecystectomy? Am J Surg . 1991;161:355-360.Crossref 16. Lillemoe KD, Yeo CJ, Talamini MA, Wang BH, Pitt HA, Gadacz TR. Selective cholangiography: current role in laparoscopic cholecystectomy . Ann Surg . 1992;215:669-676.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1993

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