CHOLECYSTOCHOLANGIOGRAPHY AS ALTERNATIVE TO CYSTIC DUCT CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY

Intraoperative cholangiography may be an important adjunct to laparosc opic cholecystectomy in order to prevent bile duct lesions. Laparoscop ic cannulation of the cystic duct can be very difficult and time consu ming. We therefore developed a simple technique of cholecystocholangio graphy. The gallbladder is punctured and filled with contrast medium a fter having localised the cystic duct and put a metal clip as a landma rk. The study included 52 patients having either cholecystocholangiogr aphy or cystic duct cholangiography. In 13 out of 26 patients (50%) ch olecystocholangiography failed because of obstruction of the cystic du ct. The cholangiograms showed complete filling of the bile ducts in 5 (19%) and incomplete visualisation in 8 cases (31%). Cystic duct chola ngiography showed significantly better results with good delineation o f the biliary tree in 19 cases (73%). Five cholangiograms were subopti mal (19%) and only 2 studies failed (8%). The relation between cystic duct and common bile duct was clearly visible in 24 cases (92%) with c ystic duct cholangiography compared with 13 cases (50%) with cholecyst ocholangiography. Cystic duct cholangiography has better success rates in delineating biliary anatomy in order to prevent bile duct injury. Cholecystocholangiography is a good alternative in cases where the cys tic duct cannot be initially visualized.