Routine intra-operative cholangiography for safe laparoscopic cholecystectomy and single stage laparoscopic choledocholithotomy

Document Type : Original Article

Authors

1 Depertment of General Surgery, Ain Shams University Hospital - Cairo- Egypt

2 Depertment of General and Minimal Invasive Surgery – Landeskrankenhaus Bregenz –Bregenz – Austria

Abstract

Background: While laparoscopic cholecystectomy is widely accepted for therapy of cholecystolithiasis, controversy still exists concerning the routine use of intra-operative cholangiography (IOC) during laparoscopic cholecystectomy (LC) and its role in management of common bile duct stones at the same procedure whether it is discovered accidentally or expected   as   a   single   stage   procedure   if   respective   experience   is   available.
Methods: During laparoscopic cholecystectomy a cholangiography via the cystic duct is routinely performed. If bile duct stones are detected they are retrieved via the cystic duct or via incision of the common bile duct by insertion of a Fogarty catheter or Dormia basket. Exclusion criteria against simultaneous laparoscopic management include suspicious of malignancy, severe pancreatitis or cholangitis.
Results: From July 2005 to June 2007, 172 patients primarily underwent laparoscopic cholecystectomy at Landeskrankenhaus Bregenz (170 cases) & at Ain Shams Specialized Hospital (2 cases), IOC was successful in 157 (91.2%). Bile duct stones were found in 26 patients (15.1%), dilated ducts without stones in 6 patients (3.4%), and anatomic variations in 3 patients (1.7%). Retrieval was performed via cystic duct and common bile duct in 15 and 11 cases respectively with complete removal. There were 2 (1.1%) minor injuries of the bile duct, which were identified with IOC and repaired at the time of cholecystectomy without any consequences for the patients, while in 3 patients (1.7%) Cholecystography was done for difficult identification of cystic duct and acute inflamed gall bladder.
Conclusion: Routine intra-operative cholangiography is feasible, provides valuable information about the anatomy of the biliary tract and might aid in the prevention of bile duct injuries, thereby improving the safety of laparoscopic cholecystectomy. Also, when correct indications and surgical expertise are available, simultaneous laparoscopic management of common bile duct stones represent a safe and minimally invasive alternative to a two stage procedure approach.

Keywords

Ain Shams Journal of Surgery
Volume 1, Issue 2
July 2008
Pages 105-115

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