CHOLECYSTOCHOLANGIOGRAPHY VS CYSTIC DUCT CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY - A PROSPECTIVE CONTROLLED TRIAL

Intraoperative cholangiography performed during laparoscopic cholecyst ectomy provides an exact picture of the biliary anatomy. It may preven t iatrogenic bile duct injury and detect unsuspected common duct stone s. Laparoscopic cannulation of the cystic duct can be difficult and ti me-consuming. We therefore evaluated the simpler technique of cholecys tocholangiography by direct puncture and filling of the gallbladder wi th contrast medium. This technique was compared with cystic duct chola ngiography in a prospective controlled trial of 69 patients. Cystic du ct cholangiography (n = 38) showed significantly better results than c holecystocholangiography (n = 31) with optimal visualization of the bi liary tree in 29 cases (76%) and seven cases (22%), respectively. The failure rate was 8% and 52%, respectively. Delineation of the cystic d uct junction is important in order to prevent bile duct injury. The an atomy in this region was clearly delineated in 34 cases (89.5%) using cystic duct cholangiography but only in 11 cases (35.5%) with cholecys tocholangiography. Cystic duct cholangiography revealed unsuspected co mmon duct stones in three cases; however, choledocholithiasis was miss ed by cholecystocholangiography in at least two patients. Cystic duct cholangiography is clearly the optimal technique. In situations of unc lear anatomy in which safe dissection of the cystic duct is not possib le, cholecystocholangiography remains a useful alternative.