Role of Routine Intraoperative Cholangiography during Laparoscopic Cholecystectomy

Ashwani Kumar, MBBS, MS, Upasna Kumar, MBBS, MS, Anand Mungaday, MBBS, Ashvind Bawa, MBBS, MS. Government Medical College, Patiala (Punjab). India.

Introduction: The study was undertaken to assess the utility, safety and cost effectiveness of routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) which can represent a systemic approach for avoiding common bile duct (CBD) injury.

Material and Method : This was a prospective study, conducted in the Department of General Surgery, Government Medical College/ Rajindra Hospital, Patiala. 100 consecutive patients suffering from symptomatic gall stones undergoing laparoscopic cholecystectomy were included in the study.

The intra-operative cholangiograms was obtained after the laparoscopic trocars were inserted, the gall-bladder grasped and retracted cephalad and the cystic duct was dissected, a large metallic clip was positioned between the gallbladder neck and the cystic duct to prevent migration of stones or flow of contrast material during cholangiography. A pediatric feeding tube (Argyle 5-French) was used for injection of contrast material. 20 cc of dilute contrast (50% Hypaque mixed 50/50 with saline) was slowly injected. Two films were taken in addition to a pre-operative scout film. The films were immediately interpreted. The catheter was taken out and the gall bladder was removed as usual, and ports were taken out after putting drain in the abdominal cavity.

Results: A total of 100 patients were included in the study with average age was 43.7 years and majority of them were females (80%). 60% of patient presented with Pain abdomen while 40% presented with dyspepsia along with pain abdomen. Out of the 100, successful cannulation of the cystic duct was achieved in 92 patients. Eighty cholangiograms showed normal biliary tree anatomy while 12 showed dilated CBD with free flow of the contrast into the duodenum but with no evidence of filling defects. There was significant additional operating time ranging from 17 to 42 minutes with mean time of 24.82 minutes. There was no intraoperative complication. Total additional cost of IOC was in range of Rs 2200 to 2500. No patient re-presented to us with biliary symptoms within 18 months of surgery.

Conclusion .: In our study, we concludes that routine IOC was successful and safe, yields information that was clinically useful for operative management. However, the operating time was significantly longer but there was no significant difference in the hospital stay and furthere decreases the admission rate with post cholecystectomy syndrome, which occurs in 10%-40% of the post cholecystectomy patients.

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