Aims:
To stress the importance of on-table cholangiogram (OTC) during a laparoscopic cholecystectomy (LC) and how it identifies potentially significant problems. Methods: Three consultant general surgeons perform routine on-table cholangiograms. Five hundred LCs from January 2001 to 2004, identified from the theatre computer operation record system, were studied. Failure to perform a cholangiogram was examined. Outcomes of abnormal cholangiograms were studied. Results: Five hundred patients underwent LC. Some 440 (88%) had an OTC and 60 (12%) did not have an OTC. A total of 31/60 (52%) were converted to open cholecystectomy due to adhesions. A number of patients (29/60, 48%) could not have an OTC for technical reasons: failure to cannulate the cystic duct (n = 17), leakage of contrast (5), others (7). Some 53/440 (12%) OTCs were abnormal. Eight of these were converted to open cholecystectomy: two because the common bile duct (CBD) had been cannulated and six had multiple CBD stones. Twenty-four abnormal OTCs resulted in further intervention postoperatively. Eighteen patients had an endoscopic retrograde cholangiopancreaticography (ERCP) (7 normal, 11 ductal stone removal) and 5/24 had normal magnetic resonance cholangiopancreaticography (MRCP). One patient developed fatal pancreatitis before his scheduled ERCP. Twenty-one had minor abnormalities such as mild ductal dilatation, air bubbles or possible small stones. None have developed problems. Conclusions: OTC was successfully performed in 96% of LCs and is technically easy even for trainees. Besides the greater clinical advantage, OTC is essential to avoid serious CBD injury or missing CBD stones, as it is highly cost beneficial as compared to the price one pays for a single litigation.
Laparoscopy 6261