Indocyanine Green Navigated Early Laparoscopic Cholecystectomy in Post ERCP Patients for Choledochocystolithiasis

Abstract

Background: Although use of I.V ICG has been done in past for difficult cholecystectomies,but post ercp patients does’nt show proper biliary anatomy due to free flow of bile.Dye instillation using retrograde route through NBD tube is an ideal and novel technique and provide excellent real time view of biliary anatomy. Material and Methods: This is a retrospective observational study from July 2107 to May 2021.Total 44 pts underwent ERCP and NBD placement(with or without CBD stent) followed by day 2 laparoscopic cholecystectomy were given ontable ICG dye intraoperatively through NBD tube.Real time biliary anatomy and prevention of complications taken into account. Results: 44 patients underwent surgery.Male female ratio was 19:26.Median age was 45 yr.uncomplicated cholelithiasis was found in 20 patients,19 were acute cholecystitis,3 were chronic cholecystitis and 3 were with Mirzzi’s syndrome.In 4 patients biliary tract was not visualised as nbd tube was misplaced.Of these 2 pts were having Mirrzi’s,1 with acute cholecystitis and 1 uncomplicated cholelithiasis.Tabled 1Fluorescent cholangiographyCystic ductCBDCHDCystic duct-CHD junctionBefore Calot’s Dissection15 (33%)30 (66.7%)30 (66.7%)25 (55.6%)After Calot’s Dissection (At Critical view of safety)39 (86.7%)41 (91.1%)40 (88.9%)41 (91.1%) Open table in a new tab Conclusions: ICG dye through NBD tube provides excellent alternative for Realtime fluorescent cholangiography in Post ERCP patients.