title: Bile duct injury during laparoscopic cholecystectomy without intraoperative cholangiography: a retrospective study on 1,100 selected patients.
abstract: BACKGROUND
  Whether to routinely or selectively use intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has been a controversial issue for many years. Many authors maintain that IOC decreases the rate of biliary complications such as bile duct injuries, biliary leak, and missed common bile duct (CBD) stones. However, in contrast to these claims, many centers have opted to perform LC without IOC. In this retrospective study, the results of a series of 1,100 LCs, all of which involved major biliary complications and which were performed without the use of IOC, were reviewed.
  
  
  METHODS
  Data from 1,100 selected patients (728 females and 372 males) undergoing LC without the use of IOC from January 2003 to November 2011 were analyzed. One hundred and seventy LCs were performed by young surgeons during the learning curve, and 930 by surgeons with over 10 years of experience. Two techniques were used to create pneumoperitoneum: the Veress technique in 319 cases (29%) and the Hasson technique in the remaining 781 cases (71%). Patients with a suspicion of CBD stones were excluded from the study.
  
  
  RESULTS
  Two CBD injuries (0.18%) and three biliary leaks (0.27%) were detected among this group. Thirty-three patients (3%) needed conversion to open cholecystectomy. Missed CBD stones were reported in 4 cases (0.36%). There was no postoperative mortality.
  
  
  CONCLUSIONS
  LC can be performed safely without the use of IOC and with acceptable low rates of biliary complications. An accurate preoperative evaluation of clinical risk factors, precise operative procedures, and conversion to an open approach in doubtful cases are important measures which must be taken to prevent CBD injury.
authors.affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy. nino.fish@hotmail.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesce
authors.forename: Teresa Rosanna
authors.initials: TR
authors.lastname: Portale
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Minutolo
authors.forename: Roberto
authors.initials: R
authors.lastname: Scilletta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Li Destri
authors.forename: Stefano
authors.initials: S
authors.lastname: Puleo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D001658:Biliary Fistula / Q000209:etiology* / Q000601:surgery; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome