Changes in gallbladder surgery: comparative study 4 years before and 4 years after laparoscopic cholecystectomy.

Operative procedures on the gallbladder and biliary ducts have undergone a profound transformation since the introduction of laparoscopic techniques in general surgery. As the benefits of minimally invasive procedures become universally known, patients are seeking surgery at an earlier stage, resulting in an increased number of cases for elective surgery and a considerable reduction in emergency operations, morbidity, need for intraoperative cholangiography (IOC), fewer common bile duct (CBD) explorations, shortened hospital stay, and reduced overall costs. The early criteria for IOC and the need for CBC explorations must be reevaluated in view of the observed changes and appropriate modifications made. Looking at the present trends, it seems that the routine use of IOC is not justified in the average patient who presents for laparoscopic cholecystectomy with no history of jaundice or pancreatitis, normal liver function tests, and a normal-size CBD on ultrasonography. Under those conditions, the chance of leaving an unsuspected stone in the CBD is less than 1%; and if it happens the stone can be easily retrieved by endoscopic sphincterotomy as an outpatient procedure.