title: Does routine intraoperative cholangiography prevent bile duct transection?
abstract: BACKGROUND
  The role of routine intraoperative cholangiography is controversial. The aim of this study was to assess the impact of routine intraoperative cholangiography on the incidence of common bile duct injuries, and to evaluate the operative outcome of laparoscopic cholecystectomy carried out in a major teaching hospital and review the literature.
  
  
  METHODS
  Prospectively collected data on 3,145 laparoscopic cholecystectomies performed mainly by surgical trainees in the period 1990 to 2002 using routine intraoperative cholangiography with fluoroscopy were reviewed.
  
  
  RESULTS
  The mean age of the study sample (65.6% male, 34.4% female) was 54 years, and 16.9% of the patients had clinical acute cholecystitis. The conversion rate to open cholecystectomy was 4.3%. Intraoperative cholangiography was attempted for 90.7% of the patients with a 95.9% success rate. Five patients (0.16%) had common bile duct injuries. Four injuries had occurred in the first 5 years. One injury (0.06%) had occurred after 1995. This injury was identified intraoperatively and repaired laparoscopically. Routine intraoperative cholangiography prevented one definite common bile duct transection.
  
  
  CONCLUSIONS
  In this series using routine intraoperative cholangiography, there was a low rate and severity of common bile duct injuries, with a high intraoperative recognition rate. There was no bile duct transection or major injury requiring common bile duct reconstruction. Although intraoperative cholangiography helped in the immediate identification of injuries and the institution of appropriate therapy, injury was not completely prevented.
authors.affiliation: Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, The University of Sydney, Hospital Road, Sydney, NSW, 2139, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Debru
authors.forename: A
authors.initials: A
authors.lastname: Dawson
authors.forename: S
authors.initials: S
authors.lastname: Leibman
authors.forename: M
authors.initials: M
authors.lastname: Richardson
authors.forename: L
authors.initials: L
authors.lastname: Glen
authors.forename: J
authors.initials: J
authors.lastname: Hollinshead
authors.forename: G L
authors.initials: GL
authors.lastname: Falk
mesh_terms: D000328:Adult; D001652:Bile Ducts / Q000293:injuries*; D002758:Cholangiography / Q000706:statistics & numerical data; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome