Background and Study Aims: One reason why many surgeons do not attempt lapa
roscopic cholangiography is that it is considered to be technically difficu
lt and to produce poor-quality images.
Patients and Methods: A retrospective comparison was made of twenty randoml
y selected intraoperative cholangiograms taken during laparoscopic cholecys
tectomy for each year from 1991 to 1994 (n = 80) by assigning a score (0-4)
on the basis of anatomical parameters and radiographic quality. Twenty ran
domly selected intraoperative cholangiograms taken during open cholecystect
omy (OC) were used as controls.
Results: The average score for the laparoscopic cholangiograms (LCs) was si
gnificantly lower than the average for OC cholangiograms (2.3 vs. 3.4, P <
0.001), In addition, a learning curve was demonstrated, which showed signif
icant improvement in the quality of LCs over the years. Analysis showed tha
t in LCs, only 34% succeeded in demonstrating the entire biliary tree and o
nly 49% managed to show the extrahepatic duct system. Choledocholithiasis c
ould only be ruled out in 53 % of LC films, compared with 80 % of controls.
Conclusions: Despite an improvement in the quality of laparoscopic cholangi
ography, it remains inferior to cholangiography during open cholecystectomy
, Recommendations are made regarding ways in which improvements could be ac
hieved.