To remove the myth that intraoperative cholangiogram (IOC) is essential to avoid duct injuries during laparoscopic cholecystectomy (LC), a study was done at the University of Ottawa, Ontario, Canada, by John W. Lorimer and Robert J. Fairfield-Smith. In this study 525 patients underwent LC from March 1991 to September 1993 without IOC. There were no common bile duct (CBD) injuries during this study. The indications for LC were chronic cholecystitis (82.1%), acute cholecystitis (9.1%), gallstones pancreatitis (5.6%), and jaundice (3.2%). Gallstones were present in 98.3% of cases. The median operative time was 79.5 min. Twentyfive patients (4.8%) were converted to open cholecystectomy. The reasons for conversion were dense adhesions (20 cases), inadequate exposure of gallbladder due to obesity (three cases), small-bowel injury (one case), and cystic artery bleeding (one case). Based on clinical criteria of history of jaundice, acute pancreatitis, elevated liver enzymes, and ultrasound-proven or -suspicion of common duct stone, preoperative endoscopic retrograde cholangiography (ERC) was performed in 33 patients. Out of these 33 cases, 13 patients were diagnosed as having CBD calculi (diagnostic accuracy of 40%) and treated with endoscopic sphincterotomy (ES). In the postoperative period (up to 15 months after LC), ERC was done in 14 patients, and five patients required ES for removal of their CBD stones. It was believed that three other patients in the postoperative group has passed duct stones before ERC (episodic biliary pain and elevated liver enzymes). One patient with an asymptomatic duct stone refused a second attempt at ES. Thus the incidence of CBD stones (22 out of 525 cases) was 4.2% and the incidence of retained or missed stone (nine out of 525) was 1.66%. Out of 47 patients (9%) (33 pre-op and 14 postop) subjected to ERC/ES, four patients developed a complication. Duodenal perforation occurred in one patient and pancreatitis occurred in the other three. Out of 525 patients undergoing LC, 28 complications (one fatal) occurred in 25 patients with a morbidity of 4.8% and a mortality of 0.19%. Based on these data the authors recommend the selective use of preoperative ERC/ES based on clinical, biochemical, and ultrasound evidence of CBD stone. As well, they argue that routine IOC is unnecessary, citing a study in which IOC was routinely employed, yet ERC/ES was still required in 11% of patients as compared to 9% in this series, suggesting that IOC may not reduce the dependence on ERC/ES.