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55486

Selective Intraoperative Transcystic Cholangiogaraphy in Laparoscopic Cholecystectomy, 3 Years' Experience

Article

Last updated: 24 Dec 2024

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Abstract

Background: Use of intraoperative cholangiography (IOC), a contrast-based examination of the biliary system during laparoscopic cholecystectomy (LC) still represents a valuable approach to illustrate biliary duct anatomy, diagnose obstruction and avoid complications. Objective: The aim of work was to detect the advantages of IOC when used in selected cases during LC in diagnosis of biliary obstruction and prevention of biliary injuries. Patients and methods: 29 patients with specific criteria were included in the study to perform LC and IOC after preoperative magnetic resonance cholangio pancreatogaraphy (MRCP). Follow-up was done by clinical examination, serum bilirubin and U/S for one year. Collected data had been statistically analyzed. Results: IOC resulted in significant increase in mean surgical time with longer time in cases with pericholecystic fluid and mucocele. IOC still has a higher specificity, sensitivity and positive predictive value (PPV) (100, 87.5&100% respectively) over MRCP (65, 77.8&50% respectively) in prediction of choledocholithiasis. U/S, MRCP & IOC had high negative predictive values (NPV), good negative tests. History of obstructive jaundice had a low sensitivity, specificity and PPV (71.5, 63.6&38.5) but had a high NPV (87.5%) in detection of choledocholithiasis. Normal IOC saved 8 patients with history of obstructive jaundice from unnecessary endoscopic retrograde cholangiopancreatography (ERCP). No biliary injuries had been reported. Conclusion: selective IOC in high risk patients is useful in detection of choledocholithiasis, avoidance of ERCP in patients with non-specific common bile duct (CBD) dilatation and prevention of biliary injuries in cases with high risk for injury.

DOI

10.21608/ejhm.2019.55486

Keywords

Laparoscopic cholecystectomy, MRCP, selective intraoperative cholangiogram, biliary injuries

Authors

First Name

Ayman Helmy

Last Name

Ibrahim

MiddleName

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Affiliation

Departments of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Email

aymanmohamedmed.b@azhar.edu.eg

City

-

Orcid

0000-0001-6864-9082

Volume

77

Article Issue

3

Related Issue

7685

Issue Date

2019-10-01

Receive Date

2019-10-27

Publish Date

2019-10-01

Page Start

5,242

Page End

5,248

Print ISSN

1687-2002

Online ISSN

2090-7125

Link

https://ejhm.journals.ekb.eg/article_55486.html

Detail API

https://ejhm.journals.ekb.eg/service?article_code=55486

Order

25

Type

Original Article

Type Code

606

Publication Type

Journal

Publication Title

The Egyptian Journal of Hospital Medicine

Publication Link

https://ejhm.journals.ekb.eg/

MainTitle

Selective Intraoperative Transcystic Cholangiogaraphy in Laparoscopic Cholecystectomy, 3 Years' Experience

Details

Type

Article

Created At

22 Jan 2023