Laparoscopic cholecystectomy without intraoperative cholangiography.
BACKGROUND
The aim of this retrospective study was to evaluate the outcome of laparoscopic cholecystectomies (LCs) performed in our Academic Surgical Unit, and the impact of our policy not to perform intraoperative cholangiograms (IOCs) on the incidence of bile duct injuries (BDIs).


METHODS
Data was collected for the time period from 1992 (when the laparoscopic procedure was first introduced in our Unit) until 2005. During this time, 1851 patients underwent an LC. Patients with a history of jaundice, ultasonographic bile duct dilatation, bile duct stones, or deranged liver function tests were referred initially for an endoscopic retrograde cholangiopancreatography procedure. An IOC was not performed on any patient.


RESULTS
The conversion rate was 23.9% among the patients with acute cholecystitis and 1.6% among the patients with a noninflamed gallbladder. This difference was statistically significant. The morbidity reached 1.1%, as minor or major complications were present in 22 of 1851 patients. Complications consisted of BDI in 7 patients (0.37%). Six patients presented with minor BDI. Two of the BDIs occurred among the group of patients with acute cholecystitis, whereas the remaining 5 occurred in the group of patients with a noninflamed gallbladder. This distribution was not statistically significant.


CONCLUSIONS
The low BDI rate in our series allowed us to recommend an LC procedure without an IOC. Performing a cholangiogram either routinely or selectively is not wrong. However, adherence to a meticulous hemostatic technique, thorough knowledge of the anatomy, and a low threshold for conversion may also enable satisfactory results to be achieved.
Zacharakis
Emmanouil
E
4th Academic Surgical Unit, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece. manoszacharakis@hotmail.com
Angelopoulos
Stamatis
S
Kanellos
Dimitrios
D
Pramateftakis
Manousos-Georgios
MG
Sapidis
Nikolaos
N
Stamatopoulos
Haralabos
H
Kanellos
Ioannis
I
Tsalis
Kostas
K
Betsis
Dimitrios
D
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000293:injuries; D019160:Endosonography; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome