AN ANALYSIS OF PERIOPERATIVE CHOLANGIOGRAPHY IN 1000 LAPAROSCOPIC CHOLECYSTECTOMIES

Background. We undertook this retrospective study to ascertain the pro per role of perioperative cholangiography in the management of 1002 pa tients undergoing laparoscopic cholecystectomy for symptomatic choleli thiasis. Methods. Nine hundred forty-one patients were categorized as being at high or low risk for choledocholithiasis according to the pre sence or absence of jaundice, pancreatitis, elevated bilirubin, alkali ne phosphatase, serum glutamic-oxaloacetic transaminase, or radiograph ic evidence of common bib duct stones (CBDSs). Results. Intraoperative cholangiography (IOCG) and preoperative endoscopic retrograde cholang iopancreatography (ERCP) were equivalent in the detection of CBDSs, an d laparoscopic common bib duct exploration (CBDE) was successful in 12 of the 21 patients (57%) in whom it was attempted. The ducts of the o ther 52 patients with CBDSs were successfully cleared by preoperative or postoperative ERCP. Conclusions. Laparoscopic IOCG is successful in detecting CBDS in high-risk patients and half of these ducts can be c leared laparoscopically. The incidence of CBDS in low-risk patients is 1.7%, a risk that does not warrant routine cholangiography. These dat a suggest ERCP should be reserved for those at-risk individuals in who m IOCG or laparoscopic duct clearance has been unsuccessful.