Can intraoperative cholangiography be avoided during laparoscopic cholecystectomy?
Controversy exists as to whether intraoperative cholangiography should be performed routinely or selectively during laparoscopic cholecystectomy. The aim of the present study was to assess in which circumstances intraoperative cholangiography can be avoided during laparoscopic cholecystectomy. From January 1999 to June 2002, 168 patients undergoing laparoscopic cholecystectomy for cholelithiasis without intraoperative cholangiography were prospectively evaluated at our Department. Inclusion criteria were established according to a preoperative diagnostic protocol, considering only those patients with normal liver function tests and ultrasound common bile duct diameters < or = 5 mm or > 5 mm, but with normal magnetic resonance cholangiopancreatography findings. Laparoscopic cholecystectomy was carried out without intraoperative cholangiography and postoperative results and follow-up data were recorded and analysed. No major biliary injuries were encountered and no patients had residual bile duct stones after at least a one-year postoperative follow-up. A complete preoperative diagnostic work-up proved to be of fundamental importance for decreasing the incidence of residual bile duct stones. When protocol criteria are satisfied, intraoperative cholangiography may be safely omitted during laparoscopic cholecystectomy and meticulous laparoscopic technique is the main way to reduce the incidence of iatrogenic biliary lesions to a minimum.
Uccheddu
Alessandro
A
Dipartimento di Chirurgia, Semeiotica Chirurgica, Università di Cagliari, Centro di Studio per la Chirurgia Laparoscopica Avanzata in Chirurgia Generale, Cagliari.
Pisanu
Adolfo
A
Cois
Alessandro
A
Cillara
Nicola
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008111:Liver Function Tests; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography