THE ROLE OF INTRAVENOUS CHOLANGIOGRAPHY IN PREOPERATIVE ASSESSMENT FOR LAPAROSCOPIC CHOLECYSTECTOMY

With the advent of laparoscopic cholecystectomy, pre-operative identif ication of calculi in the common bile duct has become increasingly imp ortant. In patients without clinical or biochemical evidence of common bile duct calculi, debate continues as to the value of intravenous ch olangiography (IVC) as a screening modality for the detection of unsus pected choledocholithiasis. In a prospective series of 180 patients, I VC was used to assess the common bile duct in 113 patients at low risk of choledocholithiasis, 51 patients at high risk underwent endoscopic retrograde cholangiography (ERC) and sphincterotomy if indicated, and in 16 patients, for a variety of reasons, no pre-operative cholangiog raphy was performed. 31% of those who had ERC and two (1.8%) of those who had IVC had duct calculi. These data do not support the routine us e of IVC in patients with no evidence of common bile duct calculi and its routine use has been discontinued.