INTRAOPERATIVE CHOLANGIOGRAPHY IS NOT ESSENTIAL TO AVOID DUCT INJURIES DURING LAPAROSCOPIC CHOLECYSTECTOMY

BACKGROUND: whether or not to perform intraoperative cholangiography (IOC) with laparoscopic cholecystectomy is controversial. The decision to perform IOC should depend on the individual Surgeon's preference for the management of choledocholithiasis. PATIENTS AND METHODS: An initial experience of 525 patients undergoing laparoscopic cholecystectomy done without IOC is reviewed. RESULTS: Suspected or proven choledocholithiasis was managed by endoscopic retrograde cholangiography with sphincterotomy if necessary. There were no bile duct injuries or bile leaks, and 9% (47) of patients underwent endoscopic investigation or treatment. There have been no secondary operations for duct stones. CONCLUSION: We think that the use of IOC to avoid bile duct injuries is not essential, and that the key to avoiding such injuries is meticulous demonstration of anatomic detail at operation. We have been satisfied with selective use of endoscopic cholangiography and sphincterotomy for the management of choledocholithiasis.