Role of Intraoperative Cholangiography in Laparoscopic Cholecystectomy in Higher Risk Patients of Bile Duct Injuries

Abstract
Background: Intraoperative Cholangiography (IOC) during Laparoscopic Cholecystectomy (LC) is a radiologic contrast-based examination of the bile duct which can represent a systemic approach to avoid Bile Duct Injuries (BDIs).
Aim of Study: The aim of this study was to evaluate the protective effect of selective use of IOC during laparoscopic cholecystectomy in patients with high risk for Bile Duct Injuries (BDIs).
Patients and Methods: This was a prospective study included 23 patients who presented for laparoscopic chole-cystectomy and had risk factors for bile duct injuries, under-went LC with IOC. Cases were analyzed as regard operative details and clinical outcomes.
Results: Cholangiography was successful in all the cases. The mean time of IOC added to LC was 22 minutes. There was a longer LC and IOC time in cases with positive CRP, pericholecystic fluid, mucocele and pyocele with positive significant differences. Although the pre-operative data 47.8% had history of obstructive jaundice, 21.7% a mucocele cases, 17.4% a pyocele cases, pericholecystic fluid in 30.4% and dilated CBD in 65.2%, only 13% showed abnormal IOC and needed further therapies (intraoperative ERCP in 2 cases and CBD exploration in 1 case). No bile duct injury in any case.
Conclusion: Intraoperative Cholangiography (IOC) was found to be safe, taking only an additional time of 22 minutes to total operative time. Although the pre-operative data, only 13% of cases needed further therapies (ERCP or CBD explo-ration). The use of IOC could be considered to improve patient safety and long term results.