SELECTIVE OPERATIVE CHOLANGIOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY

At the Raiser Foundation Hospital in Los Angeles, 1344 patients underw ent laparoscopic cholecystectomy from December 1990 through April 1994 . Intraoperative cholangiography was done selectively at the discretio n of the surgeon in only 98 (7%) of patients. The most common indicati ons were a history of jaundice, abnormalities of liver function tests, or gallstone pancreatitis. Patients with increasing or persistent liv er function test abnormalities and/or ultrasound identification of sto nes in a dilated common bile duct underwent either preoperative endosc opic retrograde cannulation of the common duct (ERCP) and endoscopic s phincterotomy or open common bile duct exploration, according to their wishes. Laparoscopic common bile duct exploration was not performed. Postoperative ERCP was performed in seven patients with suspected reta ined stones, but was normal in six. The single patient with a retained stone was successfully treated with endoscopic sphincterotomy. No pat ient had an unsuccessful ERCP or endoscopic sphincterotomy, and none r equired reoperation for a retained stone. There were no major common d uct injuries. Six patients with small stones in nondilated ducts on in traoperative cholangiography have been followed without intervention a nd remain clinically well. Routine intraoperative cholangiography is n ot essential to prevent common bile duct injury or retained stones in laparoscopic cholecystectomy patients.