VALUE OF ROUTINE INTRAOPERATIVE CHOLANGIOGRAPHY IN DETECTING ABERRANTBILE DUCTS AND BILE-DUCT INJURIES DURING LAPAROSCOPIC CHOLECYSTECTOMY

A prospective study was performed to determine the frequency and type of bile duct abnormalities, and to determine whether routine use of in traoperative cholangiography during laparoscopic cholecystectomy might aid in the prevention of bile duct injuries. Overall, anatomical aber rations of the bile ducts were found in 98 (19 per cent) of 513 cholan giograms. The most common anomalies were at the hepatic confluence and constituted different types of right hepatic subsegmental ducts drain ing separately into the biliary tree (n=43, 8.4 per cent), either clos e to the cystic duct or directly into the cystic duct. Three bile duct injuries (0.5 per cent) occurred during the study period. These resul ts show that routine intraoperative cholangiography is feasible and pr ovides valuable information about the anatomy of the biliary tract, th ereby improving the safety of laparoscopic cholecystectomy. If an inju ry to the biliary tract occurs early during operation, the cholangiogr am allows the surgeon to detect the injury, to make a prompt repair an d thereby reduce the morbidity associated with a delayed diagnosis. Ro utine use of intraoperative cholangiography is strongly recommended.