OPERATIVE CHOLANGIOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY - IS IT ESSENTIAL

This study is to evaluate the need for preoperative cholangiography du ring laparoscopic cholecystectomy when endoscopic retrograde cholangio pancreatography (ERCP) is available. Over a period of four years, 1105 consecutive patients had laparoscopic cholecystectomy. All patients, in addition to their clinical assessment, had routine liver function t ests (LFTs) and ultrasound (US) examination of the biliary tract. Preo perative ERCP was performed (diagnostic and/or therapeutic) in 107 (9. 6%) of the patients. The indications for ERCP were one or more of the following: 1) abnormal liver function test, 74 patients; 2) jaundice, 37 patients; 3) common bile duct (CBD) stone seen in US, 36 patients, and/or CBD dilatation, 46 patients; and 4) pancreatitis, 20 patients. In 41 out of 107 (38%) patients, CBD stones were present and cleared e ndoscopically. Postoperative ERCP was necessary in eight patients: to remove retained stones in the CBD (two patients), to stop bile leak (t wo patients), and to investigate the persistent abnormal LFTs in the r emaining patients. The number of patients who had evidence of retained CBD stone following laparoscopic cholecystectomy was only two. In bot h patients, endoscopic removal was successful. Therefore, it is clear that operative cholangiography in laparoscopic cholecystectomy is not essential if there is a reasonable facility for ERCP.