INTRAOPERATIVE CHOLANGIOGRAPHY IS NOT ESSENTIAL TO AVOID DUCT INJURIES DURING LAPAROSCOPIC CHOLECYSTECTOMY

BACKGROUND: whether or not to perform intraoperative cholangiography ( IOC) with laparoscopic cholecystectomy is controversial. The decision to perform IOC should depend on the individual Surgeon's preference fo r the management of choledocholithiasis. PATIENTS AND METHODS: An init ial experience of 525 patients undergoing laparoscopic cholecystectomy done without IOC is reviewed. RESULTS: Suspected or proven choledocho lithiasis was managed by endoscopic retrograde cholangiography with sp hincterotomy if necessary. There were no bile duct injuries or bile le aks, and 9% (47) of patients underwent endoscopic investigation or tre atment. There have been no secondary operations for duct stones. CONCL USION: We think that the use of IOC to avoid bile duct injuries is not essential, and that the key to avoiding such injuries is meticulous d emonstration of anatomic detail at operation. We have been satisfied w ith selective use of endoscopic cholangiography and sphincterotomy for the management of choledocholithiasis.