Laparoscopic cholecystectomy without intraoperative cholangiography.

BACKGROUND

The role of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) remains controversial. This study evaluates the outcomes of a management policy of LC without IOC.

SUBJECTS AND METHODS

Patients with symptomatic cholecystolithiasis were classified regarding their potential risk for choledocholithiasis, and those at low risk received no further investigations, whereas medium- and high-risk patients underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and/or endoscopic retrograde cholangiopancreatography (ERCP) with duct clearance. Those who required duct exploration were excluded. LC proceeded without IOC. Data were collected prospectively.

RESULTS

Between 2002 and 2011, 717 consecutive patients underwent LC; 168 (23.4%) were classified as medium or high risk, and 57 of those had preoperative duct clearance at ERCP. The conversion rate from LC to open surgery was 4.7%. The morbidity rate was 3.9%, and there were no mortalities. Nineteen patients in the low-risk group were re-admitted, of whom three patients (0.4% of 717 patients) had choledocholithiasis on ERCP. Minor bile duct injury occurred in 3 patients, and a fourth developed ischemic bile duct stricture 7 months following open conversion.

CONCLUSIONS

The selective use of preoperative MRCP and ERCP to detect and treat choledocholithiasis facilitates the safe application of a policy of LC without IOC. Careful operative technique is necessary to avoid duct injury.