Abstract
Background: In 100 consecutive patients who underwent laparoscopic cholecystectomy, the feasibility, reliability, and cost of routine laparoscopic cholangiography were prospectively studied.
Methods: Fluoroscopic cholangiograms with multiple exposures were successfully completed in all patients in an average time of 6.9 min.
Results: Twenty-one percent were abnormal, and 15 common duct stones and 6 significant anatomic anomalies detected. Thirteen out of 15 patients with common duct stones had preoperative suspicion of common duct stones. Two out of 15 were completely unsuspected. The average cost of cholangiography was $768, and there were no complications related to the procedure. There were no false interpretations.
Conclusions: When compared with selective preoperative endoscopic retrograde cholangiopancreatography (ERCP), routine laparoscopic cholangiography is safer, more accurate, and less costly, and may have the added benefit of potentially reducing iatrogenic injuries in patients with anatomic variations. Routine laparoscopic cholangiography should be considered by all surgeons.
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References
Arregui M, Davis C, Arkush A, Nagan R (1992) Laparoscopic cholecystectomy combined with ERCP and stone extraction and EHL for management of cholelithiasis with choledocholithiasis. Surg Endosc 6: 10–15
Baird D, Wilson J, Mason E, Ducan T, Evans J, Luke J, Ruben D, Lucas G (1992) An early review of 800 laparoscopic cholecystectomies at a university-affiliated community teaching hospital. Ann Surg 58(3): 206–210
Barkun JS, Fried GM, Barkun AN, Sigman HH, Hinchey JE, Garzon J, Wexler MJ, Meakins JL (1993) Cholecystectomy without intraoperative cholangiography. Implications for common bile duct injury and retained common bile duct stones. Ann Surg 218(3): 371–379
Berci G, Hamlin JA, eds (1981) Operative biliary radiology. Williams & Wilkins, Baltimore
Burrell M, et al (1991) The biliary tract: imaging for the 1990's. AJR 157: 223–233
Carroll B, Phillips E, Chandra M, Fallas M (1993) Laparoscopic transcystic duct dilation of the sphincter of Oddi. Surg Endosc 7: 514–517
Carroll B, Phillips E, et al. Laparoscopic transcystic choledochoscopy. Surg Endosc (in press)
Carroll B, Phillips E (1993) Laparoscopic removal of common duct stones. Gastrointest Endosc Clin North Am 3(2)
Clair D, Carr-Locke D, Becker J, Brooks D (1993) Routine cholangiography is not warranted during laparoscopic cholecystectomy. Arch Surg 128: 551–554
Cotton P, Lehman G, Vennes J, et al. (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37(3): 383–393
Jensen MH, Kairesen R, Nygaard K, Solheim Kaare, Amlie EJB, Havig O, Rosseland AR (1993) Prospective randomized study of routine intraoperative cholangiography during open cholecystectomy; long term follow up and multivariate analysis of predictors of choledocholithiasis. Surgery 113(3): 318–323
Johnson AS, Ferrara JJ, Steinbers SM, Gassen GM, Hollier LH, Flint LM (1993) The role of endoscopic retrograde cholangiography: sphincterotomy versus common bile duct exploration. Am Surg 59: 78–84
Lillemoe K, Yeo CH, Talamini M et al. (1992) Selective cholangiography. Ann Surg 215(6): 669–676
Mirizzi PL (1932) La colangiografia durante las operaciones de las vias biliares. Bol Trab Soc Cirug Buenos Aires, 16: No. 24, 1133, No. 27 1266, No. 30, 1413–1466
Morgenstern L, Wong L, Berci G (1992) Twelve hundred open cholecystectomies before the laparoscopic era: a standard for comparison. Arch Surg 127: 400–403
NIH Consensus Conference (1993) Gallstones and laparoscopic cholecystectomy. JAMA 269(8): 1018–1024
Petelin J (1993) Laparoscopic approach to common duct pathology. Am J Surg 165: 487–491
Phillips E (1993) Routine vs selective intraoperative cholangiography. Am J Surg 165: 505–507
Phillips E, Carroll B, et al. (1993) Laparoscopic choledochoscopy and extraction of common bile duct stones. World J Surg 17: 22–28
Phillips E, Daykhovsky L, Carroll B (1990) Laparoscopic cholecystectomy: instrumentation and technique. J Laparoendosc Surg 1: 3–15
Rosenthal RJ, Steigerwald S, Imig R, Brandt P, Bockhorn H Appraisal of the role of intraoperative cholangiography during laparoscopic cholecystectomy. Surg Laparosc Endosc (in press)
Soper N, Brunt L, Kerbel K (1994) New Engl J Med 330(6): 409–419
Surick B, Washington M, Ghazi A (1993) Endoscopic retrograde cholangiopancreatography in conjunction with laparoscopic cholecystectomy. Surg Endosc 7: 388–392
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Carroll, B.J., Phillips, E.H., Rosenthal, R. et al. One hundred consecutive laparoscopic cholangiograms. Surg Endosc 10, 319–323 (1996). https://doi.org/10.1007/BF00187380
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DOI: https://doi.org/10.1007/BF00187380