The standard of laparoscopic intraoperative cholangiography: A quality control study

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.