Routine cholecystocholangiography: A viable alternative during laparoscopic cholecystectomy

Background: The advantages of cholangiography during laparoscopic cholecystectomy (LC), including identification of biliary anatomy and biliary calculi, are well known. The usefulness of cholecystocholangiography (CCC), by direct injection through the gallbladder, compared to the more popular cystic duct cholangiography (CDC), however, is not so well known. Methods: Two hundred consecutive patients who underwent LC were included in a prospective study of routine CCC. Between 5 and 60 mL of contrast is injected through the gall-bladder fundus, using image intensifier control. Results: Cholecystocholangiography was attempted in 194 cases and was successful in 157 (80.9%). Twenty-one of the 37 cases with a failed CCC proceeded to have a successful CDC, giving an overall cholangiography success rate of 91.8%. The presence of acute inflammation decreased the success rate. Eleven (6%) true positive cases of common bile duct (CBD) calculi were demonstrated (nine on CCC and two on CDC after failed CCC). There was one case of false positive CBD calculus and no false negatives. Conclusions: We have found that the routine use of CCC during LC is safe, successful, quick to perform, and does not prevent conversion to attempted CDC in the cases where it fails. Cholecystocholangiography may have advantages over CDC and be an alternative as the preferred imaging technique.