INTRAVENOUS CHOLANGIOGRAPHY BEFORE 1000 CONSECUTIVE LAPAROSCOPIC CHOLECYSTECTOMIES

Background The advent of laparoscopic cholecystectomy has resulted in an increase in common bile duct (CBD) injuries. Routine intraoperative cholangiography has been advocated to prevent these injuries. This st udy describes an alternative management strategy applied to a consecut ive series of 1000 patients having laparoscopic cholecystectomy. Metho ds In patients with no history of contrast allergy and no suspicion of CBD stones, preoperative intravenous cholangiography (IVC) was perfor med routinely. Patients with suspected or detected CBD stones were ref erred for endoscopic retrograde cholangiography. This strategy was sup plemented by selective intraoperative cholangiography. Results Overall 782 of the 1000 patients had successful preoperative IVC, allowing de tection of 30 CBD stones and providing useful information about anatom ical variation in CBD anatomy. Patients with inconclusive IVC studies, or those with a history of contrast allergy, had intraoperative chola ngiography, which demonstrated a further 19 CBD stones. There were no contrast reactions and no damage to the biliary system which might hav e been obviated by intraoperative cholangiography. In the 724 patients who did not require complimentary intraoperative cholangiography, the re has been no clinical evidence of missed CBD stones. Conclusion Rout ine preoperative IVC, with reservation of intraoperative cholangiograp hy for indeterminate IVC examinations or the need for anatomical clari fication, is a safe strategy for laparoscopic cholecystectomy.