Intraoperative cholangiography and postoperative pancreatitis

Background: It has been suggested that intraoperative cholangiography (IOC) can cause postoperative pancreatitis. Methods: We studied the relationship between IOC and pancreatitis by review ing the case histories of 500 patients (1992-97) who underwent cholecystect omy at our institution. In 82% of cases, the cholecystectomies were done la paroscopically, whereas, 7% were converted to an open procedure. An IOC was performed in 435/500, or 87%. During these studies, common bile duct (CBD) stones (or the possibility of a stone) were noted in 14% of the cases. An intraoperative CBD investigation was required in nine of 435 cases or 8.5%, while 28/435 (9.2%) underwent postoperative endoscopic retrograde cholangi opancreatography (ERCP). Results: Follow-up was available in 90% of our patients (452/500). We found six cases of postoperative pancreatitis; only three of 452 (0.6%) occurred <1 year after cholecystectomy. None of these patients had a preoperative h istory of pancreatitis. In all six cases, there appeared to be an etiology for the pancreatitis unrelated to IOC. Conclusion: We could find no statistical association between IOC and postop erative pancreatitis. Postoperative pancreatitis is uncommon at our institu tion, where routine IOC is employed. Therefore, we conclude that IOC does n ot cause pancreatitis.