PEROPERATIVE CHOLANGIOGRAPHY THROUGH THE GALLBLADDER (CHOLECYSTOCHOLANGIOGRAPHY) DURING LAPAROSCOPIC CHOLECYSTECTOMY

The indications and best technique for peroperative cholangiography du ring laparoscopic cholecystectomy remain unclear, but the operation ha s been associated with an increased use of preoperative endoscopic ret rograde cholangiography. Cystic duct cholangiography, particularly in the hands of the trainee, can be time consuming, and bile duct injury may be caused by attempts to cannulate the cystic duct. This study ana lyses 113 consecutive patients undergoing peroperative cholangiography through the gallbladder, or cholecystocholangiography. It was success ful in 92 (81.4%) patients, the procedure adding less than 10 min to t he operating time. There were no cholangiogram-related complications. Common anatomical variations included both short and particularly wide cystic ducts. This information helps to minimize the risk of damage t o the common bile duct. This study demonstrates that cholecystocholang iography is a safe, simple, and effective alternative to cystic duct c holangiography with virtually no ''learning curve.'' It provides a ''r oad-map'' of biliary anatomy and identifies common bile duct stones pr ior to the commencement of dissection. Unsuccessful cholecystocholangi ography does not preclude the use of cystic duct cholangiography later in the operation. Difficult anatomy is demonstrated prior to dissecti on. When unsuspected bile duct calculi necessitate open exploration, f urther laparoscopic dissection is avoided.