Routine intraoperative laparoscopic cholangiography

BACKGROUND: Whether intraoperative laparoscopic cholangiography should be r outine is debatable, METHODS: We reviewed the cholangiography experience in 669 consecutive lapa roscopic cholecystectomies. RESULTS: Mean age of the patients was 39 years, 78% were female, and 29% ha d acute cholecystitis, Cholecystectomy was completed laparoscopically in 60 6 (91%), Laparoscopic cholangiography was completed in 562 (93%) and 348 (6 2%) were routine (no preoperative indication). The mean operating time in 1 996 was 61 minutes, Out of the 348 routine cholangiograms, 17 demonstrated evidence of unsuspected choledocholithiasis, Five patients had choledocholi thiasis documented by laparoscopic common bile duct exploration and/or endo scopic retrograde cholangiopancreatography. Two patients had normal postope rative cholangiopancreatography. One of 10 patients managed expectantly was readmitted postoperatively with obstructive jaundice, In 4 patients, routi ne cholangiography revealed unexpected anatomy, and in 2, this prevented mi sidentification and transection of the common bile duct, CONCLUSION: Laparoscopic cholangiography is safe, quick, detects unsuspecte d choledocholithiasis, and can prevent common bile duct transection, It sho uld be routine, Am J Surg. 1998; 176:632-637, (C) 1998 by Excerpta Medica, Inc.