title: Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study.
abstract: BACKGROUND
  The ongoing debate between routine and selective users of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has not yet come to an end. Routine users argue that IOC decreases the rate of biliary complications such as bile duct injury, biliary leak and missed common bile duct (CBD) stones, a claim that selective users do not fully support. On the other hand, a third policy that was adopted by many other centers is performing LC without IOC. In this retrospective study, we are exploring the results of a relatively large multicenter series of LC without IOC regarding major biliary complications.
  
  
  METHODS
  We performed a retrospective analysis of LC cases operated by experienced laparoscopic surgeons, without resorting to IOC, in four surgical units of university hospitals in Egypt during a 6-year period (January 2004 through December 2009). Excluded from the study were cases with positive predictors of CBD stones, namely, sonographically detected CBD dilatation and/or CBD stones, elevated bilirubin and/or alkaline phosphatase, persistent biliary pancreatitis, cholangitis, and those who had preoperative magnetic resonance cholangiography.
  
  
  RESULTS
  Of the 2,955 cases of LC reviewed, 241 were excluded, leaving 2,714 cases enrolled in the study. Fifty-five cases (2%) were converted to open surgery. Five cases (0.18%) had major bile duct injuries requiring surgical repair. Postoperative bile leakage was encountered in seven cases (0.26%). Missed CBD stones were reported in six cases (0.22%). There was no perioperative mortality in the present study.
  
  
  CONCLUSIONS
  LC can be performed safely without the use of IOC, with acceptable low rates of biliary complications provided that proper detection of patients with silent CBD stones is done and facilities for pre- and postoperative endoscopic retrograde cholangiopancreatography are available.
authors.affiliation: Department of Surgery, Assiut University Hospital, Assiut 71516, Egypt. mostafa_hamad@yahoo.com
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: Hamad
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Nada
authors.forename: Mohamad Y
authors.initials: MY
authors.lastname: Abdel-Atty
authors.forename: Ahmad S
authors.initials: AS
authors.lastname: Kawashti
mesh_terms: D000293:Adolescent; D000328:Adult; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000293:injuries*; D001660:Biliary Tract Diseases / Q000209:etiology*; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D003951:Diagnostic Errors; D004322:Drainage; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D055815:Young Adult