Usefulness of both operative cholangiography and conversion to decrease major bile duct injuries during laparoscopic cholecystectomy.
OBJECTIVE
We evaluated the role of operative cholangiography and of conversion to decrease major bile duct injuries.


METHODS
We report 1074 patients who underwent laparoscopic cholecystectomy, out of a total of 1195 patients who underwent laparoscopy, over an 8-year period. The planned laparoscopic operative procedure in all the patients was the standard four-port technique with the operator on the left side of the patient. Operative cholangiography was performed with Olsen's pliers.


RESULTS
We performed 993 (83%) operative cholangiographies; 121 (10.1%) patients were converted from laparoscopic to open cholecystectomy. Despite a prolonged time of dissection, 54 (4.5%) patients were converted because of unclear anatomy of Calot's triangle. One hundred and ninety patients suffered acute cholecystitis and, of those, 52 (27.3% of 190 patients) were converted. Fifteen patients showed intraoperative biliary duct stones and they were converted. Seven (0.58%) bile duct injuries (one stricture and six fistulas) are reported.


CONCLUSIONS
The low number of major bile duct injuries reported in our study showed the value of operative cholangiography during laparoscopic cholecystectomy. Moreover, another important factor found to reduce major bile duct injuries was conversion when, despite accurate dissection, the anatomy of Calot's triangle remained unclear.
Caratozzolo
Ezio
E
Fourth Unit of Surgery, Regional Reference Center of Hepato-Biliary-Pancreatic Surgery, Regional Hospital "CA Foncello", Piazza Ospedale, 31100, Treviso, Italy.
Massani
Marco
M
Recordare
Alfonso
A
Bonariol
Luca
L
Antoniutti
Michele
M
Jelmoni
Alessandro
A
Bassi
Nicoló
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries*; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies