Safe laparoscopic cholecystectomy without intraoperative cholangiography

Routinary or selective use of intraoperative cholangiography (IOC) is debated. We consider 721 laparoscopic cholecystectomy (LC) for symptomatic cholelitiasis. In 62 patients a POC was performed. In 41 (5.7%) patients an endoscopic cholangiography was performed with finding of CBD stones in 35 (85.4%). An IOC was carried out in two patients (0.28%) with suspicion of CBD stones in which endoscopic cholangiography was not successfull. Biliary injury occurred in 4 patients (0.55%) and diagnosis was made intraoperatively without IOC in all cases. Three patients (0.4%) suffered from retained CBD stones and were treated with post-operative endoscopic sphincterotomy. Four patients (0.55%) were readmitted because of bile leakage from the cystic duct, resolved endoscopically in three cases and by laparotomy in one case. IOC is not necessary in preventing bile duct injury. CBD stones can be diagnosed on the basis od clinical, biochemical and ultrasonographic criteria with good results.