M. C. Nally1, P. Patel1, J. Myers1, M. Luu1 1Rush University Medical Center,General Surgery,Chicago, IL, USA
Introduction: The utility of intraoperative cholangiography continues to be debated in the literature. Some surgeons perform routine cholangiography, while most use it selectively as an adjuvant tool in specific clinical situations. There is evidence to suggest that the use of cholangiography decreases the incidence of common bile duct injuries. It is also documented to cause increased operative times and cost, and, with the manipulation of the cystic duct during cholangiography, the procedure itself may actually lead to bile duct injury. Intraoperative cholangiography is also performed when there is a question of choledocholithiasis as it is diagnostic and can allow for therapeutic common bile duct exploration. Although with increasing availability of endoscopy, ERCP remains a pre and post operative option for management of choledocholithiasis.
Methods: A single institution retrospective chart review was performed to identify patients who underwent laparoscopic cholecystectomy completed between 2007 and 2013. Of those patients, the ones who underwent intraoperative cholangiogram were selected for further analysis. Specifically, hyperbilirubinemia, cholangiogram findings, attending surgeon, and need for common bile duct exploration were evaluated.
Results: Of the patients who underwent laparoscopic cholecystectomy (n=1590), 229 cholangiograms were performed (14.4%). Only 8.3% of the cholangiograms reported abnormal findings, which led to fifteen common bile duct explorations (6.6%). Two-thirds of these patients had elevated bilirubin, while the remaining one-third had normal liver enzymes. Twenty different attending surgeons performed intraoperative cholangiography over seven years. One attending performed 129 of these procedures (56%).
Conclusion: Intraoperative cholangiography continues to be used selectively and routinely depending on surgeon preference. When performed, the majority of cholangiograms do not show anatomic or pathologic abnormalities. And, even with the finding of choledocholithiasis on cholangiography, common bile duct exploration is, at times, deferred in favor of pursuing post operative endoscopic retrograde cholangiopancreatography. Overall, from this chart review, there does not appear to be specific indications or benefit of pursuing intraoperative cholangiography.