The routine use of intraoperative cholangiography during laparoscopic cholecystectomy is controversial.
In this study, physicians from Iran evaluated data from 2130 consecutive laparoscopic cholecystectomies.
In the first 4 years of the study, 800 patients underwent laparoscopic cholecystectomy and selective intraoperative cholangiography was performed.
In the following 5 years, 1330 patients underwent laparoscopic cholecystectomy with routine intraoperative cholangiography.
In the selective group, 159 patients met the criteria and intraoperative cholangiography was successful in 89% of cases.
|Common bile duct injury occurred only in the selective group.|
The team found bile duct calculi in 9 patients.
They determined that the incidence of ductal stones was 1%.
Sensitivity, specificity, negative predictive value and positive predictive value for the detection of ductal stones were 50, 100, 99 and 100%, respectively.
In the routine group, intraoperative cholangiography was routinely attempted in 1330 patients and was successful in 91%.
The physicians detected bile duct stones in 37 patients.
The incidence of ductal stones, sensitivity, specificity, negative predictive value, and positive predictive value were 3, 97, 100, 100, and 100%, respectively. This result was significantly higher for success rate, incidence, sensitivity, and negative predictive value.
In addition, the team found that abnormal intraoperative cholangiography findings were also significantly higher in the routine group.
Dr Nickkholgh's team concluded, "Routine intraoperative cholangiography during laparoscopic cholecystectomy is a safe, accurate, quick, and cost-effective method for the detection of bile duct anatomy and stones".
"A highly disciplined performance of routine intraoperative cholangiography can minimize potentially debilitating and hazardous complications of bile duct injury".