Intraoperative cholangiography is still indicated after preoperative endoscopic cholangiography for gallstone disease

Background: Intraoperative cholangiography (IOC) is frequently omitted in patients undergoing laparoscopic cholecystcctomy (LC) if they have had successful preoperative endoscopic retrograde cholangiography (ERC). Methods: A prospectively maintained divisional laparoscopic cholecystectomy database was searched from 1991 to 1997 for patients who had IOC after preoperative ERC. The presence of recurrent or residual common duct stones seen on IOC and their impact on subsequent management were evaluated. Results: We identified a group of 127 patients who underwent preoperative ERC. Thirty-one patients (31/127, or 24%) went on to receive an IOC during cholecystectomy. In 15 patients whose preoperative ERC was reported normal, five (33%) had an abnormal IOC. In 16 patients whose ERC was reported as having cleared the duct, eight (50%) had an IOC abnormality. Fight of these 31 patients required a further procedure to clear the duct. Conclusion: Retained or recurrent common duct stones at cholecystectomy following diagnostic or therapeutic ERC were more common than expected. Therefore, IOC is recommended during LC regardless of the findings yielded by the preoperative ERC.