Routine laparoscopic cholangiography: A means of avoiding unnecessary endoscopic retrograde cholangiopancreatography

Controversy exists between routine and selective on-table cholangiography d uring laparoscopic cholecystectomy. Endoscopic retrograde cholangiopancreat ography (ERCP) has been suggested as first-line investigation in patients w ith suspected duct stones. We report a series of 154 on-table cholangiogram s (OTC) and consider the requirements for ERCP according to historical and biochemical markers. A retrospective review of 154 consecutive patients und ergoing laparoscopic cholecystectomy with OTC was performed. Historical and biochemical markers of duct stones were examined with respect to the neces sity of ERCP. OTC was performed, with a 100% success rate, and took similar to 10 min. Eight (5.2%) of the patients had duct stones. Only one did not have preoperative indicators of duct stones. Sixty-six patients had preoper ative markers suggesting the need for ERCP. According to the OTC findings, 59 (89.4%) of these patients would have undergone unnecessary ERCP. Routine laparoscopic OTC is advocated because it maintains expertise in the techni que and avoids unnecessary ERCP with its attendant costs and complications.