SELECTED USE OF INTRAOPERATIVE CHOLANGIOG RAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY

Routine use of intraoperative cholangiography during laparoscopic chol ecystectomy is still widely advocated and standard in many departments ; however, it is controversial. We have developed a new diagnostic str ategy for the detection of bile duct stones. The concept is based on a n ultrasound examination and on screening for the presence of six risk indicators of choledocholithiasis. A total of 120 patients undergoing laparoscopic cholecystectomy were prospectively screened for the pres ence of these six risk indicators: history of jaundice, history of pan creatitis, hyperbilirubinemia, hyperamylasemia, dilated bile duct, and unclear ultrasound findings. The sensitivity of ultrasound and intrao perative cholangiography in diagnosing bile duct stones was also evalu ated. For the detection of bile duct stones, the sensitivity was 77% f or ultrasound and 100% for intraoperative cholangiography. Twenty perc ent of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledoc holithiasis (P<0.01, chi-square test). The negative predictive value o f the total set of risk indicators was 100%. Following our diagnostic concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further su pport to the view that routine use of intraoperative cholangiography i s not necessary.