Consequences of routine peroperative cholangiography during cholecystectomy for gallstone disease: a prospective, randomized study.

Abstract

AbstractTo assess the value of routine peroperative cholangiography (PC), 457 patients undergoing cholecystectomy for gallstone disease were prospectively screened for the presence of 11 predefined criteria indicating possible choledocholithiasis. Two hundred and eighty patients who had no positive criteria and in whom preoperative endoscopic retrograde cholangiography (ERC) had not been performed were randomized to PC or no PC. The patients were followed up 12 months postoperatively, and those who had signs or symptoms of possible retained common bile duct calculi were referred to ERC. The difference in mean operative time between the 2 treatment groups was 23.3 minutes. Four patients (2.8%) in the PC group had unsuspected common bile duct calculi, and in 3 patients (2.1%), the PC was false‐positive. On follow‐up, no case of retained common bile duct calculi was found in either group. The rate of postoperative complications was significantly higher in the PC group than in the non‐PC group. It is concluded that PC should be performed only in patients with indications of common bile duct disease or in whom clarification of the anatomy is necessary.