Background
Intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is a radiologic contrast-based examination of the bile duct which can represent a systemic approach to clarify biliary anatomy and avoid complications.
Objective
The aim of this study was to evaluate the protective effect of selective use of IOC during LC.
Patients and methods
This study is a prospective study which included 46 patients through 2 years (2017, 2018) who were offered LC, having specific criteria to justify IOC, who underwent LC with IOC. Cases were analyzed as regards operative details and clinical outcomes.
Results
Cholangiography was successfully completed in all the cases. The mean time of IOC added to LC ranged from 15 to 45 min with a mean of 27.39±8.49. There was a longer LC and IOC time in cases with positive C-reactive protein, pericholecystic fluid, mucocele, and pyocele with statistically significant differences. Although the preoperative evaluation showed a history of obstructive jaundice in 47.8% of the cases, and 65.2% had dilated common bile duct, only 13% of the cases showed abnormal IOC which required further therapies (intraoperative endoscopic retrograde cholangiopancreatography in five cases and postoperative in one case); 17.3% of the cases had elevated total bilirubin; 26% of the cases had elevated direct bilirubin; 19.5% of the cases had mucocele; 15.2% of the cases had pyocele; and 30.4% of cases had pericholecystic fluid. No bile duct injuries were reported in our study.
Conclusion
IOC is a safe procedure, adding time of average 27 min to total operative time. IOC is very helpful in cases with suspected choledocholithiasis as it saves the patients unnecessary preoperative endoscopic retrograde cholangiopancreatography. The selective use of IOC can provide critical information about biliary anatomy. The routine use should be abandoned.