The Advantages of Preview Cholangiography During Laparoscopic Cholecystectomy

BACKGROUND AND OBJECTIVE: Despite the numerous and often cited benefits of routine cholangiography during laparoscopic cholecystectomy, universal application of this technique has not been realized. Surgeons who advocate selective cholangiography cite the extra cost, the low yield of unanticipated findings, and the marked increase in the duration of the operation when cholangiography is added to laparoscopic cholecystectomy. We present our experience with preview cholangiography and compare it with the transcystic-duct approach. METHODS: We attempted preview cholangiograms on 11 consecutive patients undergoing laparoscopic cholecystectomy. Successful cholangiography was determined by using established radiologic criteria. RESULTS: Preview cholangiogram was successful in all 11 patients. No complications occurred. The average time required was 110 seconds. The mean operating time was 52 minutes. These times are far better than our best accomplishments using the cystic duct cannulation method for cholangiography (mean cholangiogram time, 22 minutes, and mean operative time, 75 minutes) following the first 100 cases. CONCLUSIONS: Preview cholangiography is a safe, relatively easy, quick method for outlining the anatomy of the extrahepatic biliary tree prior to dissection necessary to remove the gallbladder with laparoscopic techniques. The ease of this approach should result in more widespread use of cholangiography during laparoscopic cholecystectomy.