title: For patients with predicted low risk for choledocholithiasis undergoing laparoscopic cholecystectomy, selective intraoperative cholangiography and postoperative endoscopic retrograde cholangiopancreatography is an effective strategy to limit unnecessary procedures.
abstract: BACKGROUND
  There is debate about whether intraoperative cholangiography (IOC) should be performed routinely or selectively during laparoscopic cholecystectomy (LC) in patients with suspected choledocholithiasis. The timing of endoscopic retrograde cholangiopancreatography (ERCP) in these patients also is an issue. We reviewed the experience in our center, where a management algorithm limiting ERCP in relation to LC was adopted.
  
  
  METHODS
  We retrospectively reviewed every LC performed by one surgeon during 6 years and the related ERCPs.
  
  
  RESULTS
  A total of 264 LCs were performed. In 30 patients, stones were cleared or excluded by preoperative ERCP. In the remaining 234 LCs, 31 of 34 IOCs were successfully performed. Two of 31 IOCs were positive for bile duct stones; stone removal was successful in each patient at subsequent ERCP. Only 10 of 201 patients who did not have IOC required postsurgical ERCP within 10 weeks of LC, 3 of whom had common bile duct stones at ERCP.
  
  
  CONCLUSIONS
  For patients who underwent LC, we performed selective IOC with postoperative ERCP for positive studies. Review of our experience using this algorithm showed it to be a powerful tool in limiting unnecessary ERCPs. Our data suggest that routine preoperative ERCP cannot be justified. Selective IOC during LC misses relatively few cases of biliary stones; these can be managed quickly by experienced endoscopists.
authors.affiliation: Division of Gastroenterology, University of British Columbia, 5135-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Michael.Byrne@vch.ca
authors.forename: Michael F
authors.initials: MF
authors.lastname: Byrne
authors.forename: Mark T
authors.initials: MT
authors.lastname: McLoughlin
authors.forename: Robert M
authors.initials: RM
authors.lastname: Mitchell
authors.forename: Henning
authors.initials: H
authors.lastname: Gerke
authors.forename: K
authors.initials: K
authors.lastname: Kim
authors.forename: Theodore N
authors.initials: TN
authors.lastname: Pappas
authors.forename: M S
authors.initials: MS
authors.lastname: Branch
authors.forename: Paul S
authors.initials: PS
authors.lastname: Jowell
authors.forename: John
authors.initials: J
authors.lastname: Baillie
mesh_terms: D000465:Algorithms; D019090:Case Management; D002758:Cholangiography / Q000706:statistics & numerical data; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery; D042883:Choledocholithiasis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002769:Cholelithiasis / Q000601:surgery; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D011182:Postoperative Care; D015641:Radiography, Interventional / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D019564:Unnecessary Procedures