Evaluation of Peroperative Cholangiograohy through the gallbladder (cholecysto-cholangiography) during laparoscoic cholecystectomy

Abstract

Numerous techniques for cholangiography during laparoscopic cholecystectomy have been described; almost all of which require cannulation of the cystic duct .For the infrequent user, it can be time consuming and difficult procedure. The wide variety of techniques, catheters and forceps used to aid cannulation testify to this difficulty.10 patients with symptomatizing gallbladder stones were studied in this series.5 of them were evaluated for cholecysto-cholangiography and the other 5 for transcystic-cholangiography. The success rate in cholecysto­ cholangiography approached 80% with excellent quality f"Llms obtained .Delineation of anatomy approached 85% ;75% for transcystic cholangiography; and exposure time to radiation compares favourably with cystic duct cannulation with a mean time 2.4mins. Cholecysto­ cholangiography added less than llmins to the procedure; mean 10.4mins, while transcystic cholangiography added an extra JOmins; mean Jlmins. There were no cholangiogram related complications or false positive findings in our series with a smooth foUow up period for one month. Our early experience with the procedure of cholecysto­ cholangiography, and based upon the results of our study we conclude that laparoscopic cholecysto-cholangiography is a safe, simple ,quick and inexpensive method of intraoperative cholangiography that can be used as an alternative to cystic duct cholangiography ;with virtually no 'learning curve"; to identify biliary anatomy prior to laparoscopic dissection whereby possible iatrogenic injury to the hepatic or common • bile duct can be avoided. The acceptJlnce of this procedure may encourage surgeons to perform cholangiography during laparoscopic cholecystectomy.