Skip to main content

Advertisement

SpringerLink
Log in

Role of Intraoperative Cholangiography in Patients Whose Biliary Tree Was Evaluated Preoperatively by Magnetic Resonance Cholangiopancreatography

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Routine performance of intraoperative cholangiography (IOC) during cholecystectomy is controversial. The aim of this study was to evaluate the role of IOC during cholecystectomy in addition to preoperative magnetic resonance cholangiopancreatography (MRCP) in our institution over a 12-year period.

Methods

A total of 425 consecutive patients who underwent IOC during cholecystectomy were included in this study. MRCP was performed preoperatively for bile duct evaluation in all patients. When common bile duct (CBD) stones were detected, they were removed endoscopically before the operation. We estimated the results of IOC in terms of the success rate, the detection rate of anatomic abnormality of the biliary system, and the incidence of residual CBD stones.

Results

MRCP preoperatively identified 6 (1.4 %) patients with abnormal biliary systems and 56 with CBD stones, which were endoscopically removed. The success rate of IOC was 93.8 % (399/425). Abnormalities of the biliary system were detected in 12 patients (12/399, 3.0 %) and CBD stones in 8 (8/399, 2.0 %). Of the eight patients with stones, seven had been examined by endoscopy preoperatively and found to have CBD stones. The detection rate of bile duct stones in patients with preoperative endoscopic removal of CBD stones (7/56, 12.5 %) was significantly higher than those with CBD stones first detected during IOC (1/365, 0.3 %) (p < 0.01). Moreover, no residual CBD stones were detected in patients who were operated on within fewer than 12 days from endoscopic treatment to the operation.

Conclusions

IOC is indicated even after preoperative sphincterotomy for CBD stones. In our study, it resulted in a 12.5 % incidence of persistent stones after sphincterotomy. IOC plays an additional role in detecting CBD stones and in revealing abnormalities of the biliary tree in patients whose biliary tree was preoperatively evaluated by MRCP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Vagenas K, Karamanakos SN, Spyropoulos C et al (2006) Laparoscopic cholecystectomy: a report from a single center. World J Gastroenterol 12:3887–3890

    PubMed  Google Scholar 

  2. Liu JJ, Alemozaffar M, McHome B et al (2008) Evaluation of real-time infrared intraoperative cholangiography in a porcine model. Surg Endosc 22:2659–2664

    Article  PubMed  Google Scholar 

  3. Metcalfe MS, Ong T, Bruening MH et al (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 187:475–481

    Article  PubMed  Google Scholar 

  4. Vecchio R, MacFadyen BV (2002) Laparoscopic common bile duct exploration. Langenbecks Arch Surg 387:45–54

    Article  PubMed  Google Scholar 

  5. Olsen D (1997) Bile duct injuries during laparoscopic cholecystectomy. Surg Endosc 1:133–138

    Article  Google Scholar 

  6. Tan JT, Suyapto DR, Neo EL et al (2006) Prospective audit of laparoscopic cholecystectomy experience at a secondary referral centre in South Australia. ANZ J Surg 76:335–338

    Article  PubMed  Google Scholar 

  7. Caratozzolo E, Massani M, Recordare A et al (2004) Usefulness of both operative cholangiography and conversion to decrease major bile duct injuries laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 11:171–175

    Article  PubMed  Google Scholar 

  8. Hamouda AH, Goh W, Mahmud S et al (2007) Intraoperative cholangiography facilitates simple transcystic clearance of ductal stones in units without expertise for laparoscopic bile duct surgery. Surg Endosc 21:955–959

    Article  PubMed  CAS  Google Scholar 

  9. Wenner DE, Whitwam P, Turner D et al (2005) Actual time required for dynamic fluoroscopic intraoperative cholangiography. JSLS 9:174–177

    PubMed  Google Scholar 

  10. Polat FR, Abci I, Coskun I et al (2000) The importance of intraoperative cholangiography during laparoscopic cholecystectomy. JSLS 4:103–107

    PubMed  CAS  Google Scholar 

  11. Palanivelu C (2007) Intraoperative cholangiography. In: Art of laparoscopic surgery: textbook and atlas. Jaypee Brothers Medical Publishers, New Delhi, pp 585–592

  12. Barkun JS, Fried GM, Barkun AN et al (1993) Cholecystectomy without operative cholangiography: implications for common bile duct injury and retained common bile duct stones. Ann Surg 218:371–379

    Article  PubMed  CAS  Google Scholar 

  13. Lepner U, Grunthal V (2005) Intraoperative cholangiography can be safely omitted during laparoscopic cholecystectomy: a prospective study of 413 consecutive patients. Scand J Surg 94:197–200

    PubMed  CAS  Google Scholar 

  14. Piacentini F, Perri S, Pietrangeli F et al (2003) Intraoperative cholangiography during laparoscopic cholecystectomy: selective or routine? G Chir 24:123–128 (in Italian)

    PubMed  CAS  Google Scholar 

  15. Collins C, Maguire D, Ireland A et al (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239:28–33

    Article  PubMed  Google Scholar 

  16. Mir IS, Mohsin M, Kirmani O et al (2007) Is intra-operative cholangiography necessary during laparoscopic cholecystectomy? A multicentre rural experience from a developing world country. World J Gastroenterol 7:4493–4497

    Google Scholar 

  17. Philip WB, David JL (1997) Magnetic resonance cholangiopancreatography. Gut 41:135–137

    Article  Google Scholar 

  18. Calvo MM, Bujanda L, Calderon A et al (2002) Role of magnetic resonance cholangiopancreatography in patients with suspected choledocholithiasis. Mayo Clin Proc 77:422–428

    PubMed  Google Scholar 

  19. Cuschieri A, Shimi S, Banting S et al (1994) A. Intraoperative cholangiography during laparoscopic cholecystectomy: routine vs selective policy. Surg Endosc 8:302–305

    Article  PubMed  CAS  Google Scholar 

  20. Lezoche E, Paganini A, Guerrieri M et al (1994) Technique and results of routine dynamic cholangiography during 528 consecutive laparoscopic cholecystectomies. Surg Endosc 8:1443–1447

    PubMed  CAS  Google Scholar 

  21. MacFadyen BV (2006) Intraoperative cholangiography: past, present, and future. Surg Endosc 20:43

    Article  Google Scholar 

  22. Ludwig K, Bernhardt J, Steffen H et al (2002) Contribution of intraoperative cholangiography to incidence and outcome of common bile duct injuries during laparoscopic cholecystectomy. Surg Endosc 16:1098–1104

    Article  PubMed  CAS  Google Scholar 

  23. Kullman E, Borch K, Lindstrom E et al (1996) Value of routine intraoperative cholangiography in detecting aberrant bile ducts and bile duct injuries during laparoscopic cholecystectomy. Br J Surg 83:171–175

    Article  PubMed  CAS  Google Scholar 

  24. Ostroff JW, LaBerge JM (2002) Endoscopic and radiologic treatment of biliary disease. In: Feldman M, Friedman LS, Sleisenger MH (eds) Gastrointestinal and liver disease: pathophysiology, diagnosis, management, 7th edn. Saunders, Philadelphia, pp 1503–1535

    Google Scholar 

  25. Carroll BJ, Friedman RL, Liberman MA et al (1996) Routine cholangiography reduces sequelae of common bile duct injuries. Surg Endosc 10:1194–1197

    Article  PubMed  CAS  Google Scholar 

  26. Mah D, Wales P, Njere I et al (2004) Management of suspected common bile duct stones in children: role of selective intraoperative cholangiogram and endoscopic retrograde cholangiopancreatography. J Pediatr Surg 39:808–812

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku Kobe, 650-0017, Japan

    Kimihiko Ueno, Tetsuo Ajiki, Hidehiro Sawa, Ippei Matsumoto, Takumi Fukumoto & Yonson Ku

Authors
  1. Kimihiko Ueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tetsuo Ajiki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hidehiro Sawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ippei Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takumi Fukumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yonson Ku
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tetsuo Ajiki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ueno, K., Ajiki, T., Sawa, H. et al. Role of Intraoperative Cholangiography in Patients Whose Biliary Tree Was Evaluated Preoperatively by Magnetic Resonance Cholangiopancreatography. World J Surg 36, 2661–2665 (2012). https://doi.org/10.1007/s00268-012-1715-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-012-1715-9

Keywords

Search

Navigation