[The intraoperative cholangiography during videolaparoscopic cholecystectomy. What is its role? Results of a non randomized study].
BACKGROUND
The routine use of intraoperative cholangiography during laparoscopic cholecystectomy remains controversial. Mirizzi was the first to recommend the use of intraoperative cholangiography in 1931 based on the high incidence of unsuspected common bile duct stones. The use of intraoperative cholangiography before common bile duct exploration reduced the incidence of unnecessary common bile duct explorations from 66% to less than 5%. With the introduction of laparoscopic cholecystectomy, an increase of incidence of bile duct injury two to four times that seen in open cholecystectomy was witnessed. The vast majority of the injuries were a direct result of the surgeon misidentifying the anatomy. The Authors report their experience in the use of intraoperative cholangiography to prevent bile duct injuries and to discover common bile duct unknown lithiasis.


METHODS
From December 2002 to January 2004 in 169 patients affected to cholecystolithiasis were undergone cholecystectomy. During this operation intraoperative cholangiography was performed routinely. The patients were divided in two groups. In the Group A the patient with high risk according to a score system. and the others in the group B.


RESULTS
The cholangiography was performed with success in the 97% of patients. It were discover common bile duct in the 17%, biliary anatomy anomalies in the 3.5%, bile duct injuries in the 0.5% and false positive in the 2.9%.


CONCLUSIONS
The Authors recommended the routinely use of intraoperative cholangiography owing to its a feasible and safe technique with a success rater greater than 90%. If a bile duct injury is going to occur because of misidentification, cholangiography will not prevent the injury, but a properly performed cholangiogram will minimize the extent of the injury. Finally, the intraoperative cholangiography can discover a common unknown bile duct lithiasis and can reduce incidence of unnecessary ERCP with subsequent complication
Ciulla
Antonio
A
Università degli studi di Palermo, Dipartimento di Chirurgia generale, Urgenza e Trapianti d'organo.
Agnello
Giuseppe
G
Tomasello
Giovanni
G
Castronovo
Gioacchino
G
Maiorana
Alfonso Maurizio
AM
Genova
Gaspare
G
D000328:Adult; D000368:Aged; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D020535:Video-Assisted Surgery