A randomized controlled trial comparing cholecystocholangiography with cystic duct cholangiography during laparoscopic cholecystectomy

Background: The rate of intraoperative cholangiography fell after the adven t of laparoscopic cholecystectomy due to the perceived difficulty of cystic duct cannulation. It is suggested that cholecystocholangiography (CCC) is a valid and easier alternative. The present study compares cystic duct chol angiography (CDC) to CCC with evaluation of procedural time, success rate, image quality, cost and radiation exposure. Methods: Patients undergoing laparoscopic cholecystectomy were randomized t o CCC (n = 40) or CDC (n = 36). Details of operative times, radiation expos ure, and use of disposable equipment were recorded prospectively. Cholangio grams were performed using image intensification and were scored from 0 to 6 according to adequacy of images. Data were analysed on an intention-to-tr eat basis with the chi-squared test, t-test or Fisher's exact test. Results: The success rate for CDC was 100% and for CCC it was 72% (P = 0.00 05). Patients with a failed CCC went on to have CDC for a success rate in t he CCC arm of 92.5%. Comparing CDC to CCC, there was no significant differe nce in cost ($30.16 vs $33.36; P = 0.11), operative time (1 h 13 min vs 1 h 3 min: P = 0.19) or cholangiogram time (8 vs 9 min; P = 0.39). There was a significant difference in screening time (0:41 vs 1:33 min; P < 0.0001), a dequate image quality (100 vs 72.5%, P = 0.0005) and procedure-related comp lications (0 vs 5; P = 0.03). Conclusions: A significant number of CCC fail. Successful CCC provides infe rior image quality and greater radiation exposure. It provides no benefit i n time or cost and cannot be recommended for operative cholangiography.