Abstract
Background
Intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is used to assess the anatomy of the biliary tree and to detect any stones contained within it. Intraoperative cholangiography may be performed either routinely or more selectively in cases where there is a high suspicion of choledocholithiasis or for those patients whose anatomy appears unclear at operation [8]. In cases where significant inflammation is present, the cystic duct may be short, thickened, or dilated and thus difficult to manipulate to obtain a satisfactory IOC.
Methods
We describe a safe, simple, reliable technique to control the “difficult” cystic duct during IOC with a vascular vessel loop instead of a surgical clip to obtain good control and avoiding extravasation of dye during IOC. The feasibility, safety, and results of this technique are described.
Results
During a 1-year period, this technique has been used in 10 patients, and it was successful in all attempted cases, with a good quality IOC obtained on the first attempt. The cystic duct was then occluded in all cases using a Vicryl “0” endoloop. One patient had a common bile duct stone and this patient received postoperative endoscopic retrograde pancreatography (ERCP). All patients were discharged home with no complications. In cases where a short, thickened, or dilated cystic duct was present, ductal control during IOC was easily obtained using a vascular vessel loop.
Conclusions
This is a safe, reliable, less traumatic, readily available, and inexpensive method that provides a secure way of handling the “difficult” cystic duct.
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References
Banich FE (1982) Simple rapid method of securing a cystic duct catheter. Surg Gynecol Obstet 155: 557–558
Daoud M, McCallum MJ (1999) An easy and effective method of cholangiography in laparoscopic cholecystectomy: laparoscopic cholecystocholangiography. Aust N Z J Surg 10: 748
Grande M (2004) Preoperative risk factors for common bile duct stones: defining the patient at high risk in the laparoscopic cholecystectomy era. J Laparoendosc Adv Surg Tech A 5: 281–286
Hampson LG, Hreno A (1984) A simple method for catheter fixation of the cystic duct during cholangiography. Surg Gynecol Obstet 159: 82–83
Hanazaki K, Igarashi J, Sodeyama H, Matsuda Y (1999) Bile leakage resulting from clip displacement of the cystic duct stump: a potential pitfall of laparoscopic cholecystectomy. Surg Endosc 2: 168–171
Hida Y, Okuyama S, Iizuka M, Katoh H (2002) New technique to ligate enlarged cystic duct using a clip applier during laparoscopy: report of a case. Hepatogastroenterology 46: 926–927
Kama NA, Doganay M, Dolapci M, Reis E, Atli M, Kologlu M (2001) Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc 9: 965–968
Metcalfe M, Ong T, Bruening M, Iswariah H, Wemys-Holden S, Maddern G (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 4: 475–481
Ota A, Kano N, Kusanagi H, Yamada S, Garg A (2003) Techniques for difficult cases of laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 2: 172–175
Smith RC. (1988) Operative cholangiography using a modified disposable vascular clip. Surg Gynecol Obstet 166: 275–276
Thompson JE, Bennion RS (1989) A simple cost effective method for operative cholangiography. Am J Surg 5: 461–462
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Fayek, S.A., Varga, C. & Lee, K. A reliable method for handling the “difficult” cystic duct to obtain a good cholangiogram during laparoscopic cholecystectomy. Surg Endosc 21, 1020–1022 (2007). https://doi.org/10.1007/s00464-007-9201-4
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DOI: https://doi.org/10.1007/s00464-007-9201-4