• Mohannad B Ammori and Amir K Al-Dabbagh.
• University of Manchester, Manchester, United Kingdom.
• J Laparoendosc Adv Surg Tech A. 2012 Mar 1;22(2):146-51.

BackgroundThe 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 MethodsPatients 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.ResultsBetween 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.ConclusionsThe 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.

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