DOES ROUTINE CYSTIC DUCT CHOLANGIOGRAM DURING LAPAROSCOPIC CHOLECYSTECTOMY PREVENT COMMON BILE-DUCT INJURY

Between November 1989 and September 1992, the author performed 1,000 l aparoscopic cholecystectomies. Three common bile duct injuries occurre d (0.3%). Selective cystic duct cholangiograms were performed for diag nosis and management of common bile duct stones. A total of 102 cholan giograms (10%) were done. Only eight of these cholangiograms were done for anatomical verification in the face of severe chronic or acute ch olecystitis. Five were cystic duct cholangiograms, resulting in two co mmon bile duct injuries. To avoid the problem of common bile duct inju ry in cases of obscure anatomy where clarification was needed, a chole cystocholangiogram was done for duct identification in three subsequen t cases without event. The third common bile duct injury occurred earl y in the learning experience without benefit of the cholangiogram.