title: Elective laparoscopic cholecystectomy without routine intraoperative cholangiography: a retrospective analysis of 1101 consecutive cases.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) is today the operation of choice for symptomatic gallstone disease. Before the laparoscopic era intraoperative cholangiography (IOC) was generally considered as a fundamental step in cholecystectomy while nowadays the role of IOC is controversial: is there a need for IOC to specify anatomy of biliary tree in order to avoid bile duct injuries (BDI) and to detect possible common bile duct (CBD) stones or not?
  
  
  METHODS
  We studied retrospectively all the elective LCs done in Turku City Hospital for Surgery during the ten years (1992-2001). Cholecystectomy was performed to 1101 patients, 874 (79%) female and 227 (21%) male patients, mean age 53y (range 15-89). LC was possible in 1022 (93%) cases while 79 (7%) had to be converted to open procedure. The number and severity of bile duct injuries were recorded. The cases with endoscopic retrograde cholangiopancreatography (ERCP) and/or magnetic resonance cholangiopancreatography (MRCP) during the follow-up and the findings in ERCP and MRCP were recorded from patient records and radiological database.
  
  
  RESULTS
  IOC was performed in 32 operations (20 in LC and 12 after conversion) and CBD stones were found in seven patients. There were four primary BDIs: two CBD injuries and two minor bile leaks. During a mean follow-up of 72 months (range 36-144) ERCP was performed in 16 and MRCP in three patients. Three patients underwent both MRCP and ERCP. CBD stones were detected in ten patients and a postoperative late CBD stricture was found in one case.
  
  
  CONCLUSIONS
  According to our data, both the incidence of BDIs (0.5%) and symptomatic postoperative CBD stones (0.9%) remain low without the routine use of IOC.
authors.affiliation: Department of Surgery, Turku University Hospital, Turku, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Lill
authors.forename: A
authors.initials: A
authors.lastname: Rantala
authors.forename: E
authors.initials: E
authors.lastname: Pekkala
authors.forename: H
authors.initials: H
authors.lastname: Sarparanta
authors.forename: H
authors.initials: H
authors.lastname: Huhtinen
authors.forename: P
authors.initials: P
authors.lastname: Rautava
authors.forename: J M
authors.initials: JM
authors.lastname: Grönroos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries*; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult