Selective Intraoperative Transcystic Cholangiogaraphy in Laparoscopic Cholecystectomy, 3 Years' Experience

Abstract

Background: Use of intraoperative cholangiography (IOC), a contrast-based examination of the biliary system during laparoscopic cholecystectomy (LC) still represents a valuable approach to illustrate biliary duct anatomy, diagnose obstruction and avoid complications. Objective: The aim of work was to detect the advantages of IOC when used in selected cases during LC in diagnosis of biliary obstruction and prevention of biliary injuries. Patients and methods: 29 patients with specific criteria were included in the study to perform LC and IOC after preoperative magnetic resonance cholangio pancreatogaraphy (MRCP). Follow-up was done by clinical examination, serum bilirubin and U/S for one year. Collected data had been statistically analyzed. Results: IOC resulted in significant increase in mean surgical time with longer time in cases with pericholecystic fluid and mucocele. IOC still has a higher specificity, sensitivity and positive predictive value (PPV) (100, 87.5&100% respectively) over MRCP (65, 77.8&50% respectively) in prediction of choledocholithiasis. U/S, MRCP & IOC had high negative predictive values (NPV), good negative tests. History of obstructive jaundice had a low sensitivity, specificity and PPV (71.5, 63.6&38.5) but had a high NPV (87.5%) in detection of choledocholithiasis. Normal IOC saved 8 patients with history of obstructive jaundice from unnecessary endoscopic retrograde cholangiopancreatography (ERCP). No biliary injuries had been reported. Conclusion: selective IOC in high risk patients is useful in detection of choledocholithiasis, avoidance of ERCP in patients with non-specific common bile duct (CBD) dilatation and prevention of biliary injuries in cases with high risk for injury.