A prospective audit of selective cholangiography for laparoscopic cholecystectomy

Background: With the introduction of laparoscopic cholecystectomy (LC) there has been a reduction in the use of operative cholangiography. The practice of selective cholangiography (SC), where the common bile duct (CBD) is imaged only in those patients where the surgeon believes there is a significant risk of CBD stones has contributed to this reduction. Selective cholangiography has been criticized by advocates of routine cholangiography who argue that there will be more CBD stones missed and more CBD injuries. Methods: This prospective study reports the outcome in a series of 457 patients who had LC performed between 1990 and 1992 where cholangiography was used according to a strict protocol relying on clinical history, CBD size and pre-operative liver function tests. There were no CBD injuries. Twenty-nine patients (6.4%) had CBD stones. Results: Follow up by structured questionnaire at 12-24 months detected 6 patients (1.3%) with CBD stones. Three of these 6 patients had cholangiograms. Of the 3 patients with missed stones and no X-ray, 2 were protocol breaches and only] patient from 307 (0.3%) with no indication for SC was subsequently found to have a CBD stone. Conclusion: We believe that this study validates a policy of SC.