A randomized controlled trial comparing cholecystocholangiography with cystic duct cholangiography during laparoscopic cholecystectomy.
BACKGROUND
The rate of intraoperative cholangiography fell after the advent of laparoscopic cholecystectomy due to the perceived difficulty of cystic duct cannulation. It is suggested that cholecystocholangiography (CCC) is a valid and easier alternative. The present study compares cystic duct cholangiography (CDC) to CCC with evaluation of procedural time, success rate, image quality, cost and radiation exposure.


METHODS
Patients undergoing laparoscopic cholecystectomy were randomized to CCC (n = 40) or CDC (n = 36). Details of operative times, radiation exposure, and use of disposable equipment were recorded prospectively. Cholangiograms were performed using image intensification and were scored from 0 to 6 according to adequacy of images. Data were analysed on an intention-to-treat basis with the chi-squared test, t-test or Fisher's exact test.


RESULTS
The success rate for CDC was 100% and for CCC it was 72% (P = 0.0005). Patients with a failed CCC went on to have CDC for a success rate in the CCC arm of 92.5%. Comparing CDC to CCC, there was no significant difference in cost ($30.16 vs $33.36: P = 0.11), operative time (1 h 13 min vs 1 h 3 min; P = 0.19) or cholangiogram time (8 vs 9 min: P = 0.39). There was a significant difference in screening time (0:41 vs 1:33 min; P < 0.0001), adequate image quality (100 vs 72.5%, P = 0.0005) and procedure-related complications (0 vs 5; P = 0.03).


CONCLUSIONS
A significant number of CCC fail. Successful CCC provides inferior image quality and greater radiation exposure. It provides no benefit in time or cost and cannot be recommended for operative cholangiography.
Wills
V L
VL
St George Upper Gastrointestinal Surgical Unit, Sydney, New South Wales, Australia.
Jorgensen
J O
JO
Hunt
D R
DR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002758:Cholangiography / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D002765:Cholecystography / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D011834:Radiation Monitoring; D015203:Reproducibility of Results; D013997:Time Factors